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Abstract: TH-PO429

Variation in Use of Antihypertensive Medications After Kidney Transplant and Associated Outcomes: A National Study

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention


  • Yamout, Hala, VA St. Louis HealthCare System, Saint Louis, Missouri, United States
  • Ouseph, Rosemary, St Louis University, St Louis, Missouri, United States
  • Schnitzler, Mark, Saint Louis Univ, St Louis, Missouri, United States
  • Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States
  • Naik, Abhijit S., University of Michigan, Ann Arbor, Michigan, United States
  • Lam, Ngan, University of Alberta, Edmonton, Alberta, Canada
  • Koraishy, Farrukh M., Saint Louis University, Saint Louis, Missouri, United States
  • Xiao, Huiling, St. Louis University, St. Louis, Missouri, United States
  • Zhang, Zidong, Saint Louis University, Saint Louis, Missouri, United States
  • Randall, Henry B., SSM Health/SLUH, St. Louis, Missouri, United States
  • Segev, Dorry L., Johns Hopkins University, Baltimore, Maryland, United States
  • Kasiske, Bertram L., Hennepin County Medical Center, Minneapolis, Minnesota, United States
  • Hess, Gregory P., LDI University of Pennsylvania/Symphony Health, Conshohocken, Pennsylvania, United States
  • Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States

Hypertension is a common comorbidity in kidney transplant (KTx) recipients. Impact of antihypertensive medication (AHM) regimen on patient and graft outcomes is not clear.


A novel database linking SRTR registry data for 54,153 KTx recipients with AHM fill records from a large pharmaceutical claims warehouse (2008-2015) was used. Mutually exclusive regimens were defined hierarchically as based in: Angiotensin converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARB), dihydropyridine calcium channel blockers (DHP-CCB), beta blockers (BB) and vasodilators/others. Associations (adjusted hazard ratio, 95% LCL aHR 95% UCL) of AHM regimen 7-12 months post-transplant with patient and graft survival over 5 years were quantified by multivariate Cox regression with adjustment for recipient, donor and transplant factors, and clustering for center.


The most common AHM post-transplant was DHP-CCB, followed by BB, ACEi/ARB, and diuretics. Regimen patterns varied by transplant centers (Fig 1). In bi-level hierarchical modeling, compared to DHP-CCB-based treatment, ACEi/ARB use was more common in those with diabetes, obesity, and mTORi-based immunosuppression. Unadjusted survival varied with AHM treatment (Fig 2). Compared to DHP-CCB reference, adjusted mortality was higher in those on NDHP-CCB (aHR and 'other' agents (aHR, but lower in those on ACEi/ARB (aHR 1.441.691.99).


While associations may in part reflect unobserved selection factors, controlled studies are needed to determine optimal AHM regimens after KTx, reduce unjustified practice variation, and inform evidence-based best practices.


  • NIDDK Support