After kidney transplantation, it is reasonable to treat patients with hypertension with a calcium antagonist on the basis of improved GFR and kidney survival.S9.3.1-2 Synopsis After kidney transplantation, hypertension is common because of preexisting kidney disease, the effects of immunosuppres- sive medications, and the presence of allograft pathology.S9.3.1-3 Transplant recipients frequently harbor multiple CVD risk fac- tors and are at high risk of CVD events. Hypertension may accelerate target organ damage and kidney function decline, particularly when proteinuria is present.S9.3.1-4 S9.3.1-6 Use of calcineurin inhibitor based immunosuppression regimens after transplantation is associated with a high (70% to 90%) prevalence of hypertension.S9.3.1-7 Hypertension is less common when calcineurin inhibitors have been used without corticosteroids in liver transplantation patients,S9.3.1-8 although prevalence rates have not differed in steroid mini- mization trials after kidney transplantation.S9.3.1-9,S9.3.1-10 Reports from long-term belatacept-based immunosuppres- sion studies indicate higher GFR and preservation of kid- ney function. However, hypertension was still present in the majority of patients, although fewer agents were needed to achieve BP goals.S9.3.1-11 Severity of hypertension and inten- sity of treatment may differ somewhat depending on the type of organ transplanted; however, most concepts relevant to kidney transplant recipients will apply to the other solid organ recipients as well. BP targets change over time after transplantation. Initially, it is important to maintain ample organ perfusion with less stringent BP targets (<160/90 mm Hg) to avoid hypoten- sion and risk of graft thrombosis. Beyond the first month, BP should be controlled to prevent target organ damage as in the nontransplantation setting.S9.3.1-12,S9.3.1-13 Hypertension after transplantation is often associated with altered circadian BP rhythm with loss of the normal nocturnal BP fallS9.3.1-14,S9.3.1-15 and, in some, a nocturnal BP rise. These changes may return to normal after a longer period of follow-up.S9.3.1-16 Recommendation-Specific Supportive Text 1. 