Quality of life in the African American Study of Kidney Disease and Hypertension: effects of blood pressure management.
BACKGROUND
The African American Study of Kidney Disease and Hypertension was a multicenter trial comparing the effects of 2 levels of blood pressure control (usual or low goal) and initial therapy with metoprolol, ramipril, or amlodipine. We examined effects of treatment-group assignment on health-related quality of life (HRQOL) measures and reported symptoms during 4 years of follow-up.


METHODS
HRQOL was assessed at baseline and annually by using the Medical Outcomes Study 36-Item Short Form (SF-36) and a symptom checklist. Using a 2-slope model, treatment effects were evaluated for change from baseline to year 1 and for average change during the first 4 years of follow-up.


RESULTS
A total of 1,094 participants were randomly assigned. Average age was 55 years, 61% were men, and the mean of the first glomerular filtration rate in the study was 46 mL/min/1.73 m2 (0.76 mL/s). No significant differences in HRQOL were seen between the low- and usual-blood-pressure groups. Reported side effects also were similar between blood-pressure groups. Mean Physical Health Component (PHC) and Mental Health Component (MHC) scores had a significantly smaller decrease in the ramipril than metoprolol group in both the initial period from baseline to year 1 (PHC, 2.08 +/- 0.56; MHC, 1.89 +/- 0.62) and during the first 4 years of follow-up (PHC, 1.60 +/- 0.44; MHC, 1.48 +/- 0.48). The MHC also had a slightly smaller decrease during the first 4 years in the ramipril group than amlodipine group (1.20 +/- 0.61).


CONCLUSIONS
Aggressive blood pressure control is well tolerated in African Americans with hypertensive kidney disease, measured by using the SF-36 and reported symptoms. The clinical significance of smaller decreases in PHC and MHC scores in the ramipril compared with metoprolol group is not clear.
Lash
James P
JP
University of Illinois, Chicago, IL 60612-7315, USA. jplash@uic.edu
Wang
Xuelei
X
Greene
Tom
T
Gadegbeku
Crystal A
CA
Hall
Yvette
Y
Jones
Kim
K
Kusek
John W
JW
Sika
Mohammed
M
Unruh
Mark
M
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000208:ethnology / Q000523:psychology*; D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology; D007674:Kidney Diseases / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D009400:Nephrosclerosis / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control; D017063:Outcome Assessment, Health Care / Q000379:methods; D011788:Quality of Life; D017257:Ramipril / Q000627:therapeutic use
D000959:Antihypertensive Agents; D017311:Amlodipine; D008790:Metoprolol; D017257:Ramipril