Safety and Efficacy of Early Introduction of Angiotensin II Receptor Blockers for Hypertension in Kidney Transplant Recipients: A Retrospective Observational Study Using Propensity Score Matching.

Kidney transplantation (KTx) is the optimal treatment for end-stage kidney disease, but hypertension after KTx is significant complication affecting graft and patient survival. Although angiotensin II receptor blockers (ARBs) are widely used, the effect of their "early" introduction on outcomes remains unclear. This retrospective observational cohort study compared KTx recipients who started ARBs within the first 14 days post-transplant (early ARB [eARB] group) to those ARBs initiated after three months (conventional group). Propensity score matching was used to align the groups. Blood pressure control, estimated glomerular filtration rate, and serum potassium levels, urinary protein, and adverse events were analyzed. Between 2020 and 2022, 174 patients underwent living-donor KTx. Propensity score matching refined this to 38 matched pairs (76 individuals), which were analyzed. No significant difference in blood pressure control was observed between the two groups at any time point. Results showed that eARB use led to significantly lower urinary protein levels at 3 months compared to the conventional group (P = .019). There were no significant differences in adverse events, including hyperkalemia, rejection, or hypotension, between groups. Potassium-lowering agents were used slightly more in the eARB group, but the difference was not significant. Although eARBs initiation appears safe and potentially beneficial for kidney transplant recipients, further studies are needed to fully understand the long-term implications of this strategy.