title: Beta and angiotensin blockades are associated with improved 10-year survival in renal transplant recipients.
abstract: BACKGROUND
  Mortality in allograft kidney transplant recipients is high, and cardiovascular disease is the leading cause of death in these patients. They have heightened activity of sympathetic and renin-angiotensin systems. We tested the hypothesis that blockade of sympathetic and renin-angiotensin systems in these patients may offer a survival benefit using a large cohort of patients with long-term follow up.
  
  
  RESULTS
  Medical records of 321 consecutive patients from our institution who had received renal transplantation between 1995 and 2003 were abstracted. Survival was analyzed as a function of pharmacological therapies adjusted for age, sex, and comorbidities. The characteristics of the 321 patients were as follows: age at transplant, 44±13 years; 40% male; 89% with hypertension; 36% with diabetes, and mean left ventricular ejection fraction of 60%. Over a follow-up of 10±4 years, there were 119 deaths. Adjusted for age, sex, diabetes, and coronary artery disease, use of a beta-blocker therapy (P=0.04) and angiotensin-converting enzyme inhibitor or receptor blocker (P=0.03) was associated with better survival. This treatment effect was seen across all major clinical subgroups and was supported by propensity score analysis. The propensity score-adjusted 10-year survival was 95% in those taking both groups of medications, 72% in those taking either of them, and 64% in those taking neither (P=0.004).
  
  
  CONCLUSIONS
  Use of beta-blocker and angiotensin blocking therapies is associated with higher survival after renal transplantation, indicating their potential protective role in this high-risk population.
authors.affiliation: Loma Linda University, Loma Linda, CA 92354, USA.
authors.forename: Waqas
authors.initials: W
authors.lastname: Aftab
authors.forename: Padmini
authors.initials: P
authors.lastname: Varadarajan
authors.forename: Shuja
authors.initials: S
authors.lastname: Rasool
authors.forename: Arputharaj
authors.initials: A
authors.lastname: Kore
authors.forename: Ramdas G
authors.initials: RG
authors.lastname: Pai
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors