title: BP, cardiovascular disease, and death in the Folic Acid for Vascular Outcome Reduction in Transplantation trial.
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±20 mmHg 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 all-cause 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.
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina; Myra_Carpenter@unc.edu.
authors.forename: Myra A
authors.initials: MA
authors.lastname: Carpenter
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;
authors.forename: Alin
authors.initials: A
authors.lastname: John
authors.affiliation: Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland;
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.affiliation: Division of Nephrology, Duke University, Durham, North Carolina;
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Smith
authors.affiliation: University of Iowa College of Medicine, Iowa City, Iowa;
authors.forename: Lawrence
authors.initials: L
authors.lastname: Hunsicker
authors.affiliation: Hennepin County Medical Center and the University of Minnesota, Minneapolis, Minnesota;
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland;
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.affiliation: Memorial Hospital of Rhode Island, Pawtucket, Rhode Island;
authors.forename: Andrew
authors.initials: A
authors.lastname: Bostom
authors.affiliation: Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina;
authors.forename: Anastasia
authors.initials: A
authors.lastname: Ivanova
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Scott
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Division of Nephrology, Wexner Medical Center, Ohio State University, Columbus, Ohio.
authors.forename: Todd
authors.initials: T
authors.lastname: Pesavento
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts;
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000517:prevention & control*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*
chemical_list: D005492:Folic Acid
keywords: blood pressure; cardiovascular disease; kidney transplantation; mortality