# Blood pressure as a modifiable risk factor for cardiovascular events in liver transplant recipients

> **NIH NIH R56** · UT SOUTHWESTERN MEDICAL CENTER · 2021 · $366,597

## Abstract

PROJECT SUMMARY
One in three liver transplant recipients will experience a cardiovascular event within one year of transplant due
to the effects of immunosuppression and a high prevalence of potentially modifiable cardiovascular risk factors,
such as high blood pressure. However, early or intensive blood pressure-lowering may potentially cause harm
in liver transplant recipients by reducing liver graft and renal function. Indeed, for liver transplant recipients, the
clinical outcomes associated with blood pressure-lowering, treatment timing and treatment strategies are
unknown. For this application, we assembled a team of experts in liver transplantation, cardiovascular
epidemiology, hypertension, and biostatistics, in order to determine patterns of blood pressure in liver
transplant recipients in the United States; quantify associations between blood pressure levels and optimal
clinical outcomes in liver transplant recipients; and identify treatment strategies of liver transplant-associated
hypertension that lower blood pressure and minimize cardiovascular events, using innovative statistical
techniques. To achieve these goals, we will measure blood pressure using both in-office and out-of-office (7-
day home blood pressure monitoring and 24-hour ambulatory blood pressure monitoring) approaches in a
prospective, observational, cohort study of 1,268 adult liver transplant recipients, recruited from five tertiary
care transplant networks (Northwestern University, University of California San Francisco, Baylor Transplant
Institute, Columbia University, University of Pennsylvania) over five years. These data will be used to assess
associations between the main exposure of blood pressure and the main outcome of incident cardiovascular
events in liver transplant recipients. Secondary outcomes will include changes in markers of liver graft or renal
function and mortality in this population. We will then merge the cohort data with the rich data contained within
the electronic health record at each participating site including information on blood pressure-lowering
medication prescribing patterns and comorbidity data. We will apply novel statistical techniques, including Q-
learning to estimate dynamic treatment regimes in liver transplant recipients, to the merged data set to assess
treatment strategies of liver transplant-associated hypertension that are differentially associated with (a) lower
blood pressure and (b) lower cardiovascular events in liver transplant recipients. These data will fill a critical
gap in our knowledge by precisely quantifying the associations between blood pressure levels and
cardiovascular events among liver transplant recipients. We will also identify treatment strategies that are most
likely to effectively reduce blood pressure as a key modifiable risk factor for cardiovascular events in liver
transplant recipients. These data are essential as the ground work for future blood pressure intervention trials
in liver transplan...

## Key facts

- **NIH application ID:** 10838640
- **Project number:** 7R56HL155093-02
- **Recipient organization:** UT SOUTHWESTERN MEDICAL CENTER
- **Principal Investigator:** Lisa B VanWagner
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $366,597
- **Award type:** 7
- **Project period:** 2021-09-20 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10838640

## Citation

> US National Institutes of Health, RePORTER application 10838640, Blood pressure as a modifiable risk factor for cardiovascular events in liver transplant recipients (7R56HL155093-02). Retrieved via AI Analytics 2026-06-14 from https://api.ai-analytics.org/grant/nih/10838640. Licensed CC0.

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