Tx Patients Fail to Meet SBP Targets

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PHILADELPHIA—Most renal transplant recipients (RTRs) fail to achieve recommended systolic blood pressure (SBP) levels despite being prescribed antihypertensive medications. Consequently, they may be at increased risk for cardiovascular disease (CVD), a study found.

Those with SBP of 140/90 or higher have a 35% increased risk of CVD compared with patients with lower SBP, Myra Carpenter, MD, of the University of North Carolina in Chapel Hill, and collaborators reported at the 2011 American Transplant Congress.

Guidelines from the National Kidney Foundation Kidney Disease Outcome Quality Initiative recommend a target SBP below 130 mm Hg in patients with chronic kidney disease and that most CKD patients be treated with a diuretic, with other medications added as necessary to achieve target pressure, the researchers noted.

Dr. Carpenter's group studied 3,380 hypertensive RTRs who participated in the FAVORIT (Folic Acid for Vascular Outcome Reduction in Transplantation) trial, a randomized controlled trial to evaluate homocysteine-lowering therapy on cardiovascular (CV) and renal outcomes. Subjects had a mean age of 52 years and were followed up for a mean of 3.8 years. Their mean SBP was 137 mm Hg. Although 96% of patients were being treated for hypertension, only 37% had SBP below 130 mm Hg and 20% were controlled at SBP below 140 mm Hg.

Of 1,015 subjects with SBP of 140 or higher but lower than 160, 91% were using antihypertensive medications.

Additionally, the study showed that more than half of the patients were not using diuretics.

After adjusting for age, gender, race, diabetes, smoking, CVD history and other potential confounders, each 10 mm Hg increment in SBP was associated with a 12% increase the risk of CVD events during follow up. Compared with participants with SBP controlled below 130 mm Hg, those with SBP of 160 mm Hg or higher were at nearly twofold increased risk for all-cause CV events.

Although the impact on CV events of targeting SBP goals below 140 mm Hg in RTRs has not yet been documented, “the observed impact of higher SBP on CV risk suggests methods to achieve lower SBP should be studied,” the authors concluded.

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