Strict blood pressure control associates with decreased mortality risk by APOL1 genotype

Elaine Ku, Michael S. Lipkowitz, Lawrence Appel, Afshin Parsa, Jennifer Gassman, David V. Glidden, Miroslaw Smogorzewski, Chi yuan Hsu

Research output: Contribution to journalArticle

Abstract

Although . APOL1 high-risk genotype partially accounts for the increased susceptibility of blacks to chronic kidney disease (CKD), whether . APOL1 associates differentially with mortality risk remains controversial. Here we evaluate the association between . APOL1 genotype and risk of death and determine whether . APOL1 status modifies the association between strict versus usual blood pressure control and mortality risk. We performed a retrospective analysis of the African American Study of Kidney Disease and Hypertension trial that randomized black participants with CKD to strict versus usual blood pressure control from 1995 to 2001. This included 682 participants with known . APOL1 genotype (157 with high-risk genotype) previously assigned to either strict (mean arterial pressure [MAP] 92 mm Hg or less) versus usual blood pressure control (MAP 102-107 mm Hg) during the trial. During a median follow-up of 14.5 years, risk of death did not differ between individuals with high- versus low-risk . APOL1 genotypes (unadjusted hazard ratio 1.00 [95% confidence interval 0.76-1.33]). However, a significant interaction was detected between the . APOL1 risk group and blood pressure control strategy. In the . APOL1 high-risk group, the risk of death was 42% lower comparing strict versus usual blood pressure control (0.58 [0.35-0.97]). In the . APOL1 low-risk group, the risk of death comparing strict versus usual blood pressure control was not significantly different (1.09 [0.84-1.43]). Thus, strict blood pressure control during CKD associates with a lower risk of death in blacks with the high-risk CKD . APOL1 genotype. Knowledge of . APOL1 status could inform selection of blood pressure treatment targets in black CKD patients.

Original languageEnglish (US)
JournalKidney International
DOIs
StateAccepted/In press - May 13 2016

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Genotype
Blood Pressure
Mortality
Chronic Renal Insufficiency
Arterial Pressure
Plague
Kidney Diseases
African Americans
Confidence Intervals
Hypertension

Keywords

  • APOL1 genotype
  • CKD
  • Mortality

ASJC Scopus subject areas

  • Medicine(all)
  • Nephrology

Cite this

Strict blood pressure control associates with decreased mortality risk by APOL1 genotype. / Ku, Elaine; Lipkowitz, Michael S.; Appel, Lawrence; Parsa, Afshin; Gassman, Jennifer; Glidden, David V.; Smogorzewski, Miroslaw; Hsu, Chi yuan.

In: Kidney International, 13.05.2016.

Research output: Contribution to journalArticle

Ku, Elaine ; Lipkowitz, Michael S. ; Appel, Lawrence ; Parsa, Afshin ; Gassman, Jennifer ; Glidden, David V. ; Smogorzewski, Miroslaw ; Hsu, Chi yuan. / Strict blood pressure control associates with decreased mortality risk by APOL1 genotype. In: Kidney International. 2016.
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abstract = "Although . APOL1 high-risk genotype partially accounts for the increased susceptibility of blacks to chronic kidney disease (CKD), whether . APOL1 associates differentially with mortality risk remains controversial. Here we evaluate the association between . APOL1 genotype and risk of death and determine whether . APOL1 status modifies the association between strict versus usual blood pressure control and mortality risk. We performed a retrospective analysis of the African American Study of Kidney Disease and Hypertension trial that randomized black participants with CKD to strict versus usual blood pressure control from 1995 to 2001. This included 682 participants with known . APOL1 genotype (157 with high-risk genotype) previously assigned to either strict (mean arterial pressure [MAP] 92 mm Hg or less) versus usual blood pressure control (MAP 102-107 mm Hg) during the trial. During a median follow-up of 14.5 years, risk of death did not differ between individuals with high- versus low-risk . APOL1 genotypes (unadjusted hazard ratio 1.00 [95{\%} confidence interval 0.76-1.33]). However, a significant interaction was detected between the . APOL1 risk group and blood pressure control strategy. In the . APOL1 high-risk group, the risk of death was 42{\%} lower comparing strict versus usual blood pressure control (0.58 [0.35-0.97]). In the . APOL1 low-risk group, the risk of death comparing strict versus usual blood pressure control was not significantly different (1.09 [0.84-1.43]). Thus, strict blood pressure control during CKD associates with a lower risk of death in blacks with the high-risk CKD . APOL1 genotype. Knowledge of . APOL1 status could inform selection of blood pressure treatment targets in black CKD patients.",
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AB - Although . APOL1 high-risk genotype partially accounts for the increased susceptibility of blacks to chronic kidney disease (CKD), whether . APOL1 associates differentially with mortality risk remains controversial. Here we evaluate the association between . APOL1 genotype and risk of death and determine whether . APOL1 status modifies the association between strict versus usual blood pressure control and mortality risk. We performed a retrospective analysis of the African American Study of Kidney Disease and Hypertension trial that randomized black participants with CKD to strict versus usual blood pressure control from 1995 to 2001. This included 682 participants with known . APOL1 genotype (157 with high-risk genotype) previously assigned to either strict (mean arterial pressure [MAP] 92 mm Hg or less) versus usual blood pressure control (MAP 102-107 mm Hg) during the trial. During a median follow-up of 14.5 years, risk of death did not differ between individuals with high- versus low-risk . APOL1 genotypes (unadjusted hazard ratio 1.00 [95% confidence interval 0.76-1.33]). However, a significant interaction was detected between the . APOL1 risk group and blood pressure control strategy. In the . APOL1 high-risk group, the risk of death was 42% lower comparing strict versus usual blood pressure control (0.58 [0.35-0.97]). In the . APOL1 low-risk group, the risk of death comparing strict versus usual blood pressure control was not significantly different (1.09 [0.84-1.43]). Thus, strict blood pressure control during CKD associates with a lower risk of death in blacks with the high-risk CKD . APOL1 genotype. Knowledge of . APOL1 status could inform selection of blood pressure treatment targets in black CKD patients.

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