BACKGROUND: Antihypertensive drugs that block the renin-angiotensin system (angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers) are recommended for patients with chronic kidney disease (CKD). A low blood pressure (BP) goal (BP, <130/80 mm Hg) is also recommended. The objective of this study was to determine the long-term effects of currently recommended BP therapy in 1094 African Americans with hypertensive CKD. METHODS: Multicenter cohort study following a randomized trial. Participants were 1094 African Americans with hypertensive renal disease (glomerular filtration rate, 20-65 mL/min/1.73 m2). Following a 3x2-factorial trial (1995-2001) that tested 3 drugs used as initial antihypertensive therapy (ACEIs, calcium channel blockers, and beta-blockers) and 2 levels of BP control (usual and low), we conducted a cohort study (2002-2007) in which participants were treated with ACEIs to a BP lower than 130/80 mm Hg. The outcome measures were a composite of doubling of the serum creatinine level, end-stage renal disease, or death. RESULTS: During each year of the cohort study, the annual use of an ACEI or an angiotensin receptor blocker ranged from 83.7% to 89.0% (vs 38.5% to 49.8% during the trial). The mean BP in the cohort study was 133/78 mm Hg (vs 136/82 mm Hg in the trial). Overall, 567 participants experienced the primary outcome; the 10-year cumulative incidence rate was 53.9%. Of 576 participants with at least 7 years of follow-up, 33.5% experienced a slow decline in kidney function (mean annual decline in the estimated glomerular filtration rate, <1 mL/min/1.73 m2). CONCLUSION: Despite the benefits of renin-angiotensin system-blocking therapy on CKD progression, most African Americans with hypertensive CKD who are treated with currently recommended BP therapy continue to progress during the long term.
RCT Entities:
BACKGROUND: Antihypertensive drugs that block the renin-angiotensin system (angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers) are recommended for patients with chronic kidney disease (CKD). A low blood pressure (BP) goal (BP, <130/80 mm Hg) is also recommended. The objective of this study was to determine the long-term effects of currently recommended BP therapy in 1094 African Americans with hypertensiveCKD. METHODS: Multicenter cohort study following a randomized trial. Participants were 1094 African Americans with hypertensive renal disease (glomerular filtration rate, 20-65 mL/min/1.73 m2). Following a 3x2-factorial trial (1995-2001) that tested 3 drugs used as initial antihypertensive therapy (ACEIs, calcium channel blockers, and beta-blockers) and 2 levels of BP control (usual and low), we conducted a cohort study (2002-2007) in which participants were treated with ACEIs to a BP lower than 130/80 mm Hg. The outcome measures were a composite of doubling of the serum creatinine level, end-stage renal disease, or death. RESULTS: During each year of the cohort study, the annual use of an ACEI or an angiotensin receptor blocker ranged from 83.7% to 89.0% (vs 38.5% to 49.8% during the trial). The mean BP in the cohort study was 133/78 mm Hg (vs 136/82 mm Hg in the trial). Overall, 567 participants experienced the primary outcome; the 10-year cumulative incidence rate was 53.9%. Of 576 participants with at least 7 years of follow-up, 33.5% experienced a slow decline in kidney function (mean annual decline in the estimated glomerular filtration rate, <1 mL/min/1.73 m2). CONCLUSION: Despite the benefits of renin-angiotensin system-blocking therapy on CKD progression, most African Americans with hypertensiveCKD who are treated with currently recommended BP therapy continue to progress during the long term.
Authors: Xuelei Wang; Julia Lewis; Lawrence Appel; DeAnna Cheek; Gabriel Contreras; Marquetta Faulkner; Harold Feldman; Jennifer Gassman; Janice Lea; Joel Kopple; Mohammed Sika; Robert Toto; Tom Greene Journal: J Am Soc Nephrol Date: 2006-09-20 Impact factor: 10.121
Authors: Fan Fan Hou; Xun Zhang; Guo Hua Zhang; Di Xie; Ping Yan Chen; Wei Ru Zhang; Jian Ping Jiang; Min Liang; Guo Bao Wang; Zheng Rong Liu; Ren Wen Geng Journal: N Engl J Med Date: 2006-01-12 Impact factor: 91.245
Authors: B R Hemmelgarn; J Zhang; B J Manns; M Tonelli; E Larsen; W A Ghali; D A Southern; K McLaughlin; G Mortis; B F Culleton Journal: Kidney Int Date: 2006-03-08 Impact factor: 10.612
Authors: Mohammed Sika; Julia Lewis; Janice Douglas; Thomas Erlinger; Donna Dowie; Michael Lipkowitz; James Lash; Denise Cornish-Zirker; Gail Peterson; Robert Toto; John Kusek; Lawrence Appel; Cynthia Kendrick; Jennifer Gassman Journal: Am J Kidney Dis Date: 2007-07 Impact factor: 8.860
Authors: M J Klag; P K Whelton; B L Randall; J D Neaton; F L Brancati; C E Ford; N B Shulman; J Stamler Journal: N Engl J Med Date: 1996-01-04 Impact factor: 91.245
Authors: Meredith A Bostrom; Lingyi Lu; Jeff Chou; Pamela J Hicks; Jianzhao Xu; Carl D Langefeld; Donald W Bowden; Barry I Freedman Journal: Hum Genet Date: 2010-06-08 Impact factor: 4.132
Authors: Barry I Freedman; Carl D Langefeld; Mariana Murea; Lijun Ma; James D Otvos; Jolyn Turner; Peter A Antinozzi; Jasmin Divers; Pamela J Hicks; Donald W Bowden; Michael V Rocco; John S Parks Journal: Nephrol Dial Transplant Date: 2011-09-19 Impact factor: 5.992
Authors: Barry I Freedman; Pamela J Hicks; Meredith A Bostrom; Mary E Cunningham; Yongmei Liu; Jasmin Divers; Jeffrey B Kopp; Cheryl A Winkler; George W Nelson; Carl D Langefeld; Donald W Bowden Journal: Kidney Int Date: 2009-01-28 Impact factor: 10.612
Authors: Adriana M Hung; Dana C Crawford; Marie R Griffin; Kristin Brown-Gentry; Michael S Lipkowitz; Edward D Siew; Kerri Cavanaugh; Julia B Lewis; T Alp Ikizler Journal: Clin J Am Soc Nephrol Date: 2009-12-03 Impact factor: 8.237
Authors: Paul K Whelton; Paula T Einhorn; Paul Muntner; Lawrence J Appel; William C Cushman; Ana V Diez Roux; Keith C Ferdinand; Mahboob Rahman; Herman A Taylor; Jamy Ard; Donna K Arnett; Barry L Carter; Barry R Davis; Barry I Freedman; Lisa A Cooper; Richard Cooper; Patrice Desvigne-Nickens; Nara Gavini; Alan S Go; David J Hyman; Paul L Kimmel; Karen L Margolis; Edgar R Miller; Katherine T Mills; George A Mensah; Ann M Navar; Gbenga Ogedegbe; Michael K Rakotz; George Thomas; Jonathan N Tobin; Jackson T Wright; Sung Sug Sarah Yoon; Jeffrey A Cutler Journal: Hypertension Date: 2016-09-12 Impact factor: 10.190