title: Long-term effects of renin-angiotensin system-blocking therapy and a low blood pressure goal on progression of hypertensive chronic kidney disease in African Americans.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins institutions, Johns Hopkins University, Baltimore, MD 21205-2223, USA. lappel@jhmi.edu
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Julia B
authors.initials: JB
authors.lastname: Lewis
authors.forename: Xuelei
authors.initials: X
authors.lastname: Wang
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lipkowitz
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Gabriel
authors.initials: G
authors.lastname: Contreras
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Rostand
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
authors.forename: Francis B
authors.initials: FB
authors.lastname: Gabbai
authors.forename: Gerald I
authors.initials: GI
authors.lastname: Schulman
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Gassman
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Lawrence Y
authors.initials: LY
authors.lastname: Agodoa
mesh_terms: D001741:Black or African American; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000208:ethnology; D017257:Ramipril / Q000627:therapeutic use*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine; D017257:Ramipril