Hypertension. The prevalence of hypertension after transplantation is at least 60% to 80%.79 Causes include steroid use, CNIs, weight gain, allograft dysfunction, native kidney disease, and, less commonly, transplant renal artery stenosis. The complications of posttransplant hypertension are presumed to be a heightened risk of cardiovascular disease and of allograft failure,83 although distinguishing cause and effect is difficult. Hypertension should thus be aggressively managed in all recipients. In general, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) guidelines for the management of hypertension in the setting of chronic kidney disease, including a target blood pressure of less than 130/80 mm Hg, are appropriate.84 Nonpharmacological measures such as weight loss, moderation of sodium intake, moderation of alcohol intake, and increased exercise have traditionally not been emphasized in transplant clinics. The dosage of steroids and CNIs should be minimized, where possible. More than 1 antihypertensive drug therapy will still be required in many cases. Diuretics, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers should be used with caution in the first 3 months after transplantation as they may elevate plasma creatinine levels and thus complicate management. Although thiazide diuretics have the advantages of being well proven to reduce the cardiovascular complications of hypertension,85 of being inexpensive, and of enhancing the antihypertensive effects of other drugs,86 they are probably underused, as has been documented in the general hypertensive population.87 While studies have shown that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are safe and effective in treating posttransplant hypertension and in reducing proteinuria in the short-term, no long-term randomized studies have been published to date confirming specific renoprotective effects of these drugs in renal transplant recipients. Nevertheless, it seems reasonable to apply the same indications for their use as in the general hypertensive population.