# Avoiding Cardiovascular Complications in Liver Transplantation through Novel Studies (ACCT NOW) in Hypertension

> **NIH NIH R01** · UT SOUTHWESTERN MEDICAL CENTER · 2024 · $806,550

## Abstract

PROJECT SUMMARY
One in three liver transplant recipients experiences a cardiovascular event within one year of transplant because
of immunosuppression medications and a high prevalence of potentially modifiable cardiovascular risk factors,
such as high blood pressure. Hypertension is the foremost modifiable risk factor for cardiovascular events in liver
transplant recipients (LTRs); however, there is insufficient evidence to guide treatment approaches (e.g., blood
pressure target level, medication choice, treatment timing) of hypertension in LTRs that maximize cardiovascular
benefit while minimizing potential harms to the liver, kidney, and brain. Intensive blood pressure lowering is
indicated in high cardiovascular risk populations and cardiac biomarker levels can aid in matching blood
pressure-lowering therapy to those most likely to benefit; however, in LTRs, concerns about the harms and
tolerability of intensive blood pressure control limit aggressive blood pressure targets in clinical practice,
highlighting a need for a precision medicine approach to hypertension management in LTRs informed by cardiac
biomarker levels. To address these knowledge gaps for clinical practice, we will conduct a prospective,
multicenter, cohort study of 1,268 LTRs and measure 7-day home blood pressure, cardiac biomarker levels,
cardiovascular events, liver graft function, renal function, and cognitive function over two years with outcomes
up to five years post-transplant. We will determine the net clinical benefit of blood pressure-lowering on target
organs in LTRs (Aim 1), determine whether cardiac biomarker levels can improve stratification of cardiovascular
risk among LTRs with elevated blood pressure or hypertension (Aim 2), and identify optimal treatment
approaches in hypertension post-liver transplant that lower blood pressure and minimize cardiovascular events
(Aim 3). Our central hypothesis is that elevated cardiac biomarker levels can inform optimal treatment
approaches for hypertension in LTRs that maximize cardiovascular benefit and minimize harms to the liver,
kidney, and brain. We will leverage the existing infrastructure of the Avoiding Cardiovascular Complications in
Liver Transplantation through Novel Studies (ACCT NOW) consortium, comprised of multidisciplinary clinicians
and researchers across six U.S. transplant centers, whose long-term goal is to establish evidence-based
guidelines for cardiovascular disease prevention in liver transplantation. The current aims, when achieved, will
(1) define hypertension treatment approaches that are most likely to effectively reduce blood pressure, a key
modifiable risk factor for cardiovascular events, without causing harm in LTRs, (2) delineate the role of cardiac
biomarkers to guide these treatment decisions, and (3) identify which LTRs are most likely to benefit from
intensive blood pressure lowering to reduce cardiovascular risk. These data are essential for design of a future
randomized type II hybrid ...

## Key facts

- **NIH application ID:** 10978983
- **Project number:** 1R01HL171207-01A1
- **Recipient organization:** UT SOUTHWESTERN MEDICAL CENTER
- **Principal Investigator:** Lisa B VanWagner
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $806,550
- **Award type:** 1
- **Project period:** 2024-08-15 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10978983

## Citation

> US National Institutes of Health, RePORTER application 10978983, Avoiding Cardiovascular Complications in Liver Transplantation through Novel Studies (ACCT NOW) in Hypertension (1R01HL171207-01A1). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10978983. Licensed CC0.

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