title: Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial.
abstract: BACKGROUND
  In chronic nephropathies, inhibition of angiotensin-converting enzyme (ACE) is renoprotective, but can further renoprotection be achieved by reduction of blood pressure to lower than usual targets? We aimed to assess the effect of intensified versus conventional blood-pressure control on progression to end-stage renal disease.
  
  
  METHODS
  We undertook a multicentre, randomised controlled trial of patients with non-diabetic proteinuric nephropathies receiving background treatment with the ACE inhibitor ramipril (2.5-5 mg/day). We randomly assigned participants either conventional (diastolic <90 mm Hg; n=169) or intensified (systolic/diastolic <130/80 mm Hg; n=169) blood-pressure control. To achieve the intensified blood-pressure level, patients received add-on therapy with the dihydropyridine calcium-channel blocker felodipine (5-10 mg/day). The primary outcome measure was time to end-stage renal disease over 36 months' follow-up, and analysis was by intention to treat.
  
  
  RESULTS
  Of 338 patients who were randomised, three (two assigned intensified and one allocated conventional blood-pressure control) never took study drugs and they were excluded. Over a median follow-up of 19 months (IQR 12-35), 38/167 (23%) patients assigned to intensified blood-pressure control and 34/168 (20%) allocated conventional control progressed to end-stage renal disease (hazard ratio 1.00 [95% CI 0.61-1.64]; p=0.99).
  
  
  CONCLUSIONS
  In patients with non-diabetic proteinuric nephropathies receiving background ACE-inhibitor therapy, no additional benefit from further blood-pressure reduction by felodipine could be shown.
authors.affiliation: Clinical Research Centre for Rare Diseases Aldo e Cele Daccò, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica, Bergamo, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Ruggenenti
authors.forename: Annalisa
authors.initials: A
authors.lastname: Perna
authors.forename: Giacomina
authors.initials: G
authors.lastname: Loriga
authors.forename: Maria
authors.initials: M
authors.lastname: Ganeva
authors.forename: Bogdan
authors.initials: B
authors.lastname: Ene-Iordache
authors.forename: Marta
authors.initials: M
authors.lastname: Turturro
authors.forename: Maria
authors.initials: M
authors.lastname: Lesti
authors.forename: Elena
authors.initials: E
authors.lastname: Perticucci
authors.forename: Ivan Nediyalkov
authors.initials: IN
authors.lastname: Chakarski
authors.forename: Daniela
authors.initials: D
authors.lastname: Leonardis
authors.forename: Giovanni
authors.initials: G
authors.lastname: Garini
authors.forename: Adalberto
authors.initials: A
authors.lastname: Sessa
authors.forename: Carlo
authors.initials: C
authors.lastname: Basile
authors.forename: Mirella
authors.initials: M
authors.lastname: Alpa
authors.forename: Renzo
authors.initials: R
authors.lastname: Scanziani
authors.forename: Gianbattista
authors.initials: G
authors.lastname: Sorba
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage; D018450:Disease Progression; D004359:Drug Therapy, Combination; D015736:Felodipine / Q000008:administration & dosage*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology* / Q000652:urine; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000150:complications; D017257:Ramipril / Q000008:administration & dosage
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D017257:Ramipril; D015736:Felodipine