Abstract 3000: Blood Pressure Imposes Different Cardiovascular Morbidity On Renal Transplant Candidates Depending On The Presence Of Concomitant Cardiovascular Disease Regardless Of Left Ventricular Function
Background: Renal transplant candidates (RTC) are at risk of cardiovascular disease (CVD) and events (MACE). We compared the impact of blood pressure on the incidence of MACE in RTC according to left ventricular (LV) function and the presence of CVD.
Methods: 956 RTC (62% men, 53 ± 11 years) were divided according to the presence of CVD (CAD, heart failure, peripheral arterial disease, and/or stroke). LV ejection fraction (EF) was obtained by echo and the mean arterial pressure (MAP) calculated during the baseline visit. The composite incidence of fatal/non-fatal MACE was determined during a median follow-up of 24 months and its rate plotted for each MAP level for RTC with and without CVD; the best curve to fit the regression model was determined by the regression coefficient (R2).
Results: The incidence of MACE was 18.4% in the overall population. RTC with concomitant CVD had a 3-fold increase in the endpoint (31.9%) compared with RTC without CVD (11.3%) (P < 0.0001). As shown by the dark lines, in RTC with (“J-shape” curve; R2 = 0.91; P < 0.0001) or without CVD (linear; R2 = 0.88; P < 0.0001), the MAP was associated with MACE. In the graph, the mean LVEF for each MAP level is represented by the bars (CVD[−]= white; CVD[+]= gray). There was no difference in the mean LVEF in RTC without CVD (P = 0.57), whereas in the group with CVD, the mean LVEF was lower in those with lower MAP (P = 0.014). Even so, in RTC with CVD and similar LVEF, those with a MAP between 101–120mmHg had the lowest rate of events.
Conclusions: In RTC, blood pressure has a different impact on the occurrence of MACE depending on the presence of CVD. In RTC with CVD, this effect seems to be stronger at extreme levels of MAP, regardless of the LV function.