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The relevance of the FAVORIT blood pressure associations
Krista L. Lentine and Daniel C. Brennan
Secondary analysis of the FAVORIT data in kidney transplant recipients showed that systolic blood pressure 140 mmHg and diastolic blood pressure <70 mmHg at trial entry were associated with increased risks of cardiovascular disease over a mean of 4years. Whether these blood pressure values are associated with mortality is unclear.
Lentine, K. L. & Brennan, D. C. Nat. Rev. Nephrol. 10, 366367 (2014); published online 6 May 2014; http://www.nature.com/doifinder/10.1038/nrneph.2014.79
Web End =doi:10.1038/nrneph.2014.79
Cardiovascular disease (CVD) is an important source of morbidity and mortality after kidney transplantation, and post-transplant CVD might be one reason why improvements in long-term patient and allograft survival have not been as impressive as improvements in acute rejection. Causes of CVD in kidney transplant recipients include traditional risk factors, such as hyper tension, as well as an array of nontraditional risk factors (for example, use of immuno suppressive drugs, renal dysfunction, hyper uric aemia and bone and mineral dysmetabolism). Hypertension is a modifiable risk factor, butthe optimal blood pressure for patients and the relationships between blood pressure, CVD and death after kidney transplantation are unclear. To help address these knowledge gaps, Carpenter etal.1 performed a post-hoc observational analysis of baseline blood pressure (at the time of trial entry) and CVD events after an average of 4years of follow-up monitoring among kidney transplant recipients enrolled in the Folic Acid for Vascular Outcomes Reduction in Transplantation (FAVORIT) trial.
The FAVORIT study showed no decrease in CVD or mortality for patients taking high-dose folate, vitamin B6 and vitaminB12
compared with those taking a multi vitamin (without folate) and low-dose vitamin B6
and vitamin B12.2 In the new secondary analysis, the authors report that, on the basis of multivariable regression models adjusted for demographic and clinical factors, each 20 mmHg increase in baseline systolic blood pressure (SBP) was associated with a 32% higher relative risk of subsequent CVD
events (hazard ratio [HR] 1.32, 95% CI 1.191.46) and a 13% higher mortality risk (HR 1.13, 95% CI 1.011.27). Furthermore, each 10 mmHg decrease in baseline diastolic blood pressure (DBP) <70 mmHg was associ ated with 31% higher relative risks of CVD (HR 1.31, 95% CI 1.061.62) and...