木瓜直播

WASHINGTON -- Controlling blood pressure (BP) in liver transplant recipients led to better renal function at 1 year, post hoc data from a randomized trial suggested.

Recipients taking medication to control their BP had an estimated glomerular filtration rate (eGFR) that was 12.2 mL/min higher at 1 year when they were able to keep their BP below 140/90 mm Hg after liver transplant, reported Elizabeth Cabrera, MD, of Northwestern Memorial Hospital in Chicago.

No association was observed between duration of BP control and eGFR for patients not on anti-hypertensives, she said at the annual Liver Meeting sponsored by the American Association for the Study of Liver Diseases.

At 1 year, slightly less than 60% of the liver transplant recipients were able to keep their BP under 140/90 mm Hg, while about 25% were able to keep it under 130/80 mm Hg, said Cabrera.

No relationship was seen between baseline systolic BP level and BP control at 1 year. Moreover, the type of anti-hypertensive did not make a significant difference, she added.

Since renal dysfunction is common among liver transplant recipients, elevated risk for heart attack or stroke is of concern. Hypertension is found in 92% of liver transplant recipients within 6 years of their procedure, Cabrera said, and about 25-50% of liver transplant recipients do go on to develop moderate to severe renal dysfunction.

In a , Northwestern researchers found that controlling BP in liver transplant recipients resulted in substantially improved survival and a lower rate of cardiovascular events.

To study the impact controlling BP over time could have on renal function after liver transplantation, Cabrera and colleagues analyzed data from the prospective, open-label , which led to the 2013 approval of the mTOR inhibitor everolimus (Zortress) for preventing liver rejection after transplant.

Researchers stratified the 679 liver transplant recipients based on whether they were treated for BP (72.6%) or not. Those on BP treatment were prescribed a median 1.9 medications at the time of randomization. Of those on BP treatment, 39.3% had an eGFR below 60 mL/min, and 60.6% had an eGFR of 60 mL/min or greater at baseline.

Overall, 52.6% of the 679 recipients had a history of hypertension, 11.8% had diabetes, 5% had dyslipidemia, and 8.4% had atherosclerotic cardiovascular disease.

BP readings were taken 2 weeks before randomization, and at each visit (weeks 3-6, at 2-6 months, at 4.5 months, at 9 months, and at 1 year). The primary outcome for the current analysis was eGFR at 1 year, applying the MDRD-4 equation.

Within the first 12 weeks, slightly over 40% of patients were able to achieve 140/90 mm Hg, and 20% achieved 130/80 mm Hg.

Linear regression analysis and cross-sectional relationships between exposure and outcome were adjusted for age, sex, race, study treatment, diabetes status, atherosclerotic cardiovascular disease status, and baseline eGFR.

Comment