title: Intensive blood-pressure control in hypertensive chronic kidney disease.
abstract: BACKGROUND
  In observational studies, the relationship between blood pressure and end-stage renal disease (ESRD) is direct and progressive. The burden of hypertension-related chronic kidney disease and ESRD is especially high among black patients. Yet few trials have tested whether intensive blood-pressure control retards the progression of chronic kidney disease among black patients.
  
  
  METHODS
  We randomly assigned 1094 black patients with hypertensive chronic kidney disease to receive either intensive or standard blood-pressure control. After completing the trial phase, patients were invited to enroll in a cohort phase in which the blood-pressure target was less than 130/80 mm Hg. The primary clinical outcome in the cohort phase was the progression of chronic kidney disease, which was defined as a doubling of the serum creatinine level, a diagnosis of ESRD, or death. Follow-up ranged from 8.8 to 12.2 years.
  
  
  RESULTS
  During the trial phase, the mean blood pressure was 130/78 mm Hg in the intensive-control group and 141/86 mm Hg in the standard-control group. During the cohort phase, corresponding mean blood pressures were 131/78 mm Hg and 134/78 mm Hg. In both phases, there was no significant between-group difference in the risk of the primary outcome (hazard ratio in the intensive-control group, 0.91; P=0.27). However, the effects differed according to the baseline level of proteinuria (P=0.02 for interaction), with a potential benefit in patients with a protein-to-creatinine ratio of more than 0.22 (hazard ratio, 0.73; P=0.01).
  
  
  CONCLUSIONS
  In overall analyses, intensive blood-pressure control had no effect on kidney disease progression. However, there may be differential effects of intensive blood-pressure control in patients with and those without baseline proteinuria. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center on Minority Health and Health Disparities, and others.)
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, 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: Lawrence Y
authors.initials: LY
authors.lastname: Agodoa
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: William H
authors.initials: WH
authors.lastname: Cleveland
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Gabriel
authors.initials: G
authors.lastname: Contreras
authors.forename: Marquetta L
authors.initials: ML
authors.lastname: Faulkner
authors.forename: Francis B
authors.initials: FB
authors.lastname: Gabbai
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Gassman
authors.forename: Lee A
authors.initials: LA
authors.lastname: Hebert
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Jamerson
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
authors.forename: Janice P
authors.initials: JP
authors.lastname: Lea
authors.forename: Julia B
authors.initials: JB
authors.lastname: Lewis
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lipkowitz
authors.forename: Shaul G
authors.initials: SG
authors.lastname: Massry
authors.forename: Edgar R
authors.initials: ER
authors.lastname: Miller
authors.forename: Keith
authors.initials: K
authors.lastname: Norris
authors.forename: Robert A
authors.initials: RA
authors.lastname: Phillips
authors.forename: Velvie A
authors.initials: VA
authors.lastname: Pogue
authors.forename: Otelio S
authors.initials: OS
authors.lastname: Randall
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Rostand
authors.forename: Miroslaw J
authors.initials: MJ
authors.lastname: Smogorzewski
authors.forename: Robert D
authors.initials: RD
authors.lastname: Toto
authors.forename: Xuelei
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000419:Albuminuria; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000208:ethnology* / Q000209:etiology
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D003404:Creatinine
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