TY - JOUR
T1 - Lessons from the African-American study of kidney disease and hypertension
T2 - An update
AU - Toto, Robert D.
N1 - Funding Information:
Hypertension, defined as elevated blood pressure, is the attributable cause for nearly 30% of new cases of end-stage kidney disease in the United States [1,2]. In most cases, there is no histologic diagnosis of hypertensive nephrosclerosis; therefore, end-stage renal disease (ESRD) attributed to hypertension is a clinical diagnosis based on routine history, physical examination, and laboratory tests. Underlying kidney disease can cause hypertension; therefore, it is possible that most patients diagnosed with ESRD from hypertension in fact have a primary kidney disease. Therefore, the true proportion of patients with ESRD caused by systemic hypertension is unknown. During the past 10 years, several long-term clinical trials have been conducted in hypertensive patients with chronic kidney disease, including diabetics and nondiabetics. Among them, only the African-American Study of Kidney Disease and Hypertension (AASK), a trial funded by the National Institutes of Health (NIH), was focused specifically on a nondiabetic hypertensive population [3]. The purpose of this report is to provide an update on important lessons learned during the course of this important trial.
PY - 2006/10
Y1 - 2006/10
N2 - Hypertension is the second leading attributable cause of end-stage renal disease in the United States today. The African-American Study of Kidney Disease and Hypertension was a randomized, double-blind, controlled trial designed to determine whether strict blood pressure (BP) control, angiotensin-converting enzyme inhibitor (ACEI)-based, or calcium channel blocker (CCB)-based regimens were superior to less strict BP control and β-blocker (BB)-based regimens, respectively. The study enrolled 1093 African Americans with hypertensive nephrosclerosis and followed them for 4 years with repeated direct measurement of glomerular filtration rate (GFR) and monitoring of end points, including rapid decline in GFR, end-stage kidney disease, and death. From this landmark study, we learned that strict BP control is achievable in this study population, but it did not slow progression of kidney disease, and we learned that an ACEI-based therapy was superior to either a BB- or CCB-based regimen. In addition, we learned that proteinuria is the most important predictor of progression of kidney disease; ACEI and CCB have differential effects on proteinuria; and a CCB-based regimen combined with strict BP control may be the next best choice to an ACEI-based regimen in this population.
AB - Hypertension is the second leading attributable cause of end-stage renal disease in the United States today. The African-American Study of Kidney Disease and Hypertension was a randomized, double-blind, controlled trial designed to determine whether strict blood pressure (BP) control, angiotensin-converting enzyme inhibitor (ACEI)-based, or calcium channel blocker (CCB)-based regimens were superior to less strict BP control and β-blocker (BB)-based regimens, respectively. The study enrolled 1093 African Americans with hypertensive nephrosclerosis and followed them for 4 years with repeated direct measurement of glomerular filtration rate (GFR) and monitoring of end points, including rapid decline in GFR, end-stage kidney disease, and death. From this landmark study, we learned that strict BP control is achievable in this study population, but it did not slow progression of kidney disease, and we learned that an ACEI-based therapy was superior to either a BB- or CCB-based regimen. In addition, we learned that proteinuria is the most important predictor of progression of kidney disease; ACEI and CCB have differential effects on proteinuria; and a CCB-based regimen combined with strict BP control may be the next best choice to an ACEI-based regimen in this population.
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U2 - 10.1007/s11906-006-0087-7
DO - 10.1007/s11906-006-0087-7
M3 - Review article
C2 - 16965728
AN - SCOPUS:33749076916
SN - 1522-6417
VL - 8
SP - 409
EP - 412
JO - Current hypertension reports
JF - Current hypertension reports
IS - 5
ER -