title: Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial.
abstract: BACKGROUND
  Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events.
  
  
  METHODS
  We randomly assigned 1,094 African Americans with hypertensive nephrosclerosis (glomerular filtration rate [GFR], 20 to 65 mL/min/1.73 m(2) [0.33 to 1.08 mL/s]) to initial antihypertensive treatment with either: (1) a beta-blocker, metoprolol; (2) an angiotensin-converting enzyme inhibitor, ramipril; or (3) a dihydropyridine calcium channel blocker, amlodipine, and either a usual-blood pressure (BP) or low-BP treatment goal. Using a design powered to detect renal outcome differences, we compared the effect of treatment on the CV event rate (cardiac death, myocardial infarction, stroke, and heart failure) during a mean follow-up period of 4.1 years and determined baseline factors that predict CV outcomes.
  
  
  RESULTS
  Thirty-one patients died of CV disease (0.7%/patient-year), and 149 patients experienced at least 1 CV outcome (3.3%/patient-year). Overall, 202 CV events (4.5%/patient-year) occurred. The CV outcome rate was not related significantly to randomized interventions. In multivariable analyses, 7 baseline risk factors remained independently associated with increased risk for the CV composite outcome after controlling for age, sex, baseline GFR, and baseline proteinuria group: pulse pressure, duration of hypertension, abnormal electrocardiogram result, non-high-density lipoprotein cholesterol level, serum urea nitrogen level, urine protein-creatinine ratio, urine sodium-potassium ratio, and annual income less than 15,000 dollars.
  
  
  CONCLUSIONS
  Neither randomized class of antihypertensive therapy nor BP level had a significant effect on the occurrence of CV events, possibly because of limited power. However, this analysis identifies unique and potentially modifiable CV risk factors in this high-risk cohort.
authors.affiliation: Charles R. Drew University of Medicine and Science, Lynwood, CA 90262, USA. knorris@ucla.edu
authors.forename: Keith
authors.initials: K
authors.lastname: Norris
authors.forename: Jacque
authors.initials: J
authors.lastname: Bourgoigne
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gassman
authors.forename: Lee
authors.initials: L
authors.lastname: Hebert
authors.forename: John
authors.initials: J
authors.lastname: Middleton
authors.forename: Robert A
authors.initials: RA
authors.lastname: Phillips
authors.forename: Otelio
authors.initials: O
authors.lastname: Randall
authors.forename: Stephen
authors.initials: S
authors.lastname: Rostand
authors.forename: Susan
authors.initials: S
authors.lastname: Sherer
authors.forename: Robert D
authors.initials: RD
authors.lastname: Toto
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Xuelei
authors.initials: X
authors.lastname: Wang
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Julia
authors.initials: J
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D001741:Black or African American; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology* / Q000503:physiopathology; D003404:Creatinine / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000208:ethnology; D006977:Hypertension, Renal / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D008875:Middle Aged; D015999:Multivariate Analysis; D009400:Nephrosclerosis / Q000150:complications* / Q000188:drug therapy* / Q000208:ethnology / Q000209:etiology; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D003404:Creatinine