(447) Impact of Systolic Blood Pressure on Risk of Cardiac Allograft Vasculopathy
Several immunologic and non-immunologic risk factors are thought to contribute to the development of cardiac allograft vasculopathy (CAV), however the impact of modifiable traditional cardiovascular risk factors such as hypertension on the risk of CAV has not been well described. In this single cen...
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| Published in: | The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S206 - S207 |
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| Main Authors: | , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier Inc
01-04-2023
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| Online Access: | Get full text |
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| Summary: | Several immunologic and non-immunologic risk factors are thought to contribute to the development of cardiac allograft vasculopathy (CAV), however the impact of modifiable traditional cardiovascular risk factors such as hypertension on the risk of CAV has not been well described. In this single center retrospective analysis, we sought to evaluate the relationship between systolic blood pressure (SBP) and prevalence of CAV.
We retrospectively identified adults (>18 years) who had undergone HT at our institution between 2011-2020. In-office BP readings were recorded from visits timed 2 months, 1-, 3-, 5-, and 10-years post-HT and averaged until first CAV event or for duration of follow up in those without CAV. Coronary angiograms performed for CAV surveillance at 2 months, 1, 3, 5, and 10 years were reviewed by two cardiologists and graded per the ISHLT classification. Subjects were categorized as high SBP (average SBP ≥140) or controlled (<140).
Of a total of 313 HT recipients, those with missing data or who did not have an angiogram were excluded; the remaining 257 were included in the study. The mean age at HT was 54±14 years and 73 HT recipients (28%) were female. In total, 121 recipients (47%) had CAV over a median follow-up time of 3±2.3 years. On time to event analysis (Figure 1), patients with high SBP were at increased risk for CAV compared to those with controlled SBP (unadjusted HR 1.98, 95% CI 1.24-3.13, p=0.003). On multivariate regression analysis, after adjusting for other known risk factors for CAV including average serum LDL, average Hemoglobin A1c, recipient age and sex, donor age and sex, history of CMV viremia, and presence of donor specific antibodies, average SBP ≥140 continued to significantly increase risk of CAV (HR 1.73; 95% CI 1.08-2.79; p=0.02), as did donor age, sex and average A1c (Figure 2).
Hypertension is associated with the development of CAV post-HT. Further studies evaluating blood pressure targets and antihypertensive therapies that can mitigate risk of CAV are required. |
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| ISSN: | 1053-2498 1557-3117 |
| DOI: | 10.1016/j.healun.2023.02.462 |