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Abstract: PO2094

Intensive BP Control Associates with Better Kidney Outcomes in Individuals with APOL1 High-Risk Genotypes

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Dinh, Alex, University of California San Francisco, San Francisco, California, United States
  • Copeland, Timothy P., University of California San Francisco, San Francisco, California, United States
  • Ix, Joachim H., University of California San Diego, La Jolla, California, United States
  • Freedman, Barry I., Wake Forest University, Winston-Salem, North Carolina, United States
  • McCulloch, Charles E., University of California San Francisco, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

Presence of two APOL1 risk variants (high-risk genotypes) are associated with risk for chronic kidney disease. However, we previously reported that intensive blood pressure (BP) control may lower mortality risk in AASK trial participants with APOL1 high-risk genotypes. Our current objective was to assess whether APOL1 genotypes modified the effect of intensive BP control on kidney outcomes in the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD BP) trial.

Methods

We performed a retrospective analysis of the ACCORD 2x2 factorial trial which randomized participants to intensive (systolic BP <120mmHg) vs. standard BP control (<140 mmHg) and intensive vs. standard glycemic control. Presence of 0-1 APOL1 risk alleles were considered low-risk genotypes and 2 APOL1 risk alleles as high-risk genotypes. Cox models were used to test for interaction between intensive BP control and APOL1 risk categories for the outcome of serum creatinine doubling or eGFR decline >20 ml/min (as defined by ACCORD). We included glycemic control assignment, age, sex, GFR, and albuminuria as covariates in adjusted models.

Results

3,108 participants (n=2,617 White, 430 Black with low-risk and 61 Black with high-risk genotypes) were included. An interaction was present between race/APOL1 genotype and intensive BP control (p <0.05). Whites assigned to intensive (vs. standard) BP control had a 85% higher adjusted risk of the kidney outcome (95% CI 1.67-2.06). Blacks with APOL1 low-risk genotypes had a 37% higher adjusted risk of the kidney outcome (95% CI 1.06-1.77), while the adjusted risk of kidney function decline was not higher with intensive (vs. standard) BP control (HR 1.00, 95% CI 0.48-2.07) in Blacks with high-risk genotype. [Figure]

Conclusion

Intensive BP control to SBP <120 mmHg associated with less kidney function decline in Blacks with APOL1 high-risk genotypes compared to Whites or Blacks with low-risk APOL1 genotypes.

Figure – Unadjusted Kaplan Meier Curve for Risk of Kidney Function Decline with Standard vs. Intensive BP Control by race and APOL1 genotype

Funding

  • NIDDK Support