Intensive blood pressure control is associated with improved patient and graft survival after renal transplantation

Sci Rep. 2019 Jul 19;9(1):10507. doi: 10.1038/s41598-019-46991-2.

Abstract

Based on data of the SPRINT trial, American hypertension guidelines recently reduced the blood pressure goal from 140/90 mmHg to 130/80 mmHg for subjects with chronic kidney disease (CKD), whereas European guidelines recommend a systolic blood pressure (SBP) of 130-139 mmHg. The present analysis investigates whether a SBP < 130 mmHg is associated with an additional benefit in renal transplant recipients. We performed a retrospective analysis of 815 renal transplant recipients who were stratified according to mean office SBP values < 130 mmHg, 130-139 mmHg or ≥140 mmHg. Patient and graft survival was defined as composite endpoint, follow-up was limited to 120 months. Mean SBP of the follow-up was significantly associated with the composite endpoint (n = 218) with better survival for a SBP < 130 mmHg and 130-139 mmHg compared to ≥140 mmHg (p < 0.001). The differences in the combined endpoint remained significant in Cox regression analysis adjusted for age, gender and eGFR (p = 0.007, HR = 0.58, 95%CI = 0.41-0.53), but not for graft survival alone. Renal transplant recipients with SBP < 130 mmHg had a lower mortality than those with the conservative blood pressure goal <140 mmHg. These data suggest that the new AHA BP targets are safe for renal transplant recipients and - with all limitations of a retrospective analysis - might even be associated with improved outcome.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure*
  • Comorbidity
  • Coronary Disease / epidemiology
  • Diabetes Mellitus / epidemiology
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Graft Survival*
  • Humans
  • Hyperlipidemias / epidemiology
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Hypertension / physiopathology
  • Immunosuppressive Agents / therapeutic use
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation* / mortality
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Recurrence
  • Retrospective Studies
  • Tissue Donors
  • Treatment Outcome
  • Young Adult

Substances

  • Antihypertensive Agents
  • Immunosuppressive Agents