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

Elaine Ku1, Michael S Lipkowitz2, Lawrence J Appel3

  • 1Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA.

Kidney International
|December 9, 2016
PubMed

Insights

Strict blood pressure control significantly lowers mortality risk in Black individuals with high-risk APOL1 genotypes and chronic kidney disease (CKD). APOL1 status may guide CKD treatment targets for Black patients.

Area of Science:

  • Nephrology
  • Genetics
  • Epidemiology

Background:

  • APOL1 high-risk genotype is linked to increased chronic kidney disease (CKD) susceptibility in Black populations.
  • The association between APOL1 genotype and mortality risk in CKD patients remains controversial.
  • Understanding APOL1's role in mortality risk and its interaction with treatment is crucial for targeted interventions.

Purpose of the Study:

  • To evaluate the association between APOL1 genotype and mortality risk in Black individuals with CKD.
  • To determine if APOL1 status modifies the effect of strict versus usual blood pressure control on mortality risk.

Main Methods:

  • Retrospective analysis of the African American Study of Kidney Disease and Hypertension trial.
  • Included 682 Black participants with known APOL1 genotype (157 high-risk) randomized to strict (MAP ≤ 92 mmHg) or usual (MAP 102-107 mmHg) blood pressure control.
  • Median follow-up of 14.5 years to assess mortality risk.

Main Results:

  • No significant difference in mortality risk between high-risk and low-risk APOL1 genotypes overall.
  • A significant interaction between APOL1 risk group and blood pressure control strategy was observed.
  • In the APOL1 high-risk group, strict blood pressure control was associated with a 42% lower risk of death compared to usual control (HR 0.58).
  • In the APOL1 low-risk group, strict blood pressure control showed no significant difference in mortality risk (HR 1.09).

Conclusions:

  • Strict blood pressure control is associated with reduced mortality risk in Black CKD patients with the high-risk APOL1 genotype.
  • APOL1 genetic status may inform personalized blood pressure treatment targets for Black CKD patients.
  • This finding highlights the importance of considering genetic factors in managing hypertension in CKD.

Keywords:
APOL1 genotypeCKDmortality

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