BP, cardiovascular disease, and death in the folic acid for vascular outcome reduction in transplantation trial

Myra A. Carpenter, Alin John, Matthew R. Weir, Stephen R. Smith, Lawrence Hunsicker, Bertram L. Kasiske, John W. Kusek, Andrew Bostom, Anastasia Ivanova, Andrew S. Levey, Scott Solomon, Todd Pesavento, Daniel E. Weiner

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

The optimal BP level in kidney transplant recipients remains uncertain. This post hoc analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) trial cohort assessed associations of BP with a pooled cardiovascular disease (CVD) outcome and with all-cause mortality. In 3474 prevalent kidney transplant patients, mean age was 52±9 years, 63% were men, 76% were white, 20% had a history of CVD, 40% had a history of diabetes mellitus, and the median time since transplant was 4.1 years (25th to 75th percentiles, 1.7-7.4);mean systolic BP was 136±20mm Hg and mean diastolic BP was 79±12 mmHg. There were 497 CVD events and 406 deaths. After adjustment for demographic and transplant characteristics and CVD risk factors, each 20-mmHg increase in baseline systolic BP associated with a 32% increase in subsequent CVD risk (hazard ratio [HR], 1.32; 95% confidence interval [95% CI], 1.19 to 1.46) and a 13% increase in mortality risk (HR, 1.13; 95% CI, 1.01 to 1.27). Similarly, after adjustment, at diastolic BP levels <70 mmHg, each 10-mmHg decrease in diastolic BP level associated with a 31% increase in CVD risk (HR, 1.31; 95% CI, 1.06 to 1.62) and a 31% increase in mortality risk (HR, 1.31; 95% CI, 1.03 to 1.66). However, at diastolic BP levels >70 mmHg, there was no significant relationship between diastolic BP and outcomes. Higher systolic BP strongly and independently associated with increased risk of CVD and allcause mortality, without evidence of a J shape, whereas only lower levels of diastolic BP associated with increased risk of CVD and death in this trial.

Original languageEnglish (US)
Pages (from-to)1554-1562
Number of pages9
JournalJournal of the American Society of Nephrology
Volume25
Issue number7
DOIs
StatePublished - Jul 1 2014

Bibliographical note

Publisher Copyright:
Copyright © 2014 by the American Society of Nephrology.

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