title: Renal outcomes in hypertensive Black patients at high cardiovascular risk.
abstract: The ACCOMPLISH trial (Avoiding Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension) was a 3-year multicenter, event-driven trial involving patients with high cardiovascular risk who were randomized in a double-blinded manner to benazepril plus either hydrochlorothiazide or amlodipine and titrated in parallel to reach recommended blood pressure goals. Of the 8125 participants in the United States, 1414 were of self-described Black ethnicity. The composite kidney disease end point, defined as a doubling in serum creatinine, end-stage renal disease, or death was not different between Black and non-Black patients, although the Blacks were significantly more likely to develop a greater than 50% increase in serum creatinine to a level above 2.6 mg/dl. We found important early differences in the estimated glomerular filtration rate (eGFR) due to acute hemodynamic effects, indicating that benazepril plus amlodipine was more effective in stabilizing eGFR compared to benazepril plus hydrochlorothiazide in non-Blacks. There was no difference in the mean eGFR loss in Blacks between therapies. Thus, benazepril coupled to amlodipine was a more effective antihypertensive treatment than when coupled to hydrochlorothiazide in non-Black patients to reduced kidney disease progression. Blacks have a modestly higher increased risk for more advanced increases in serum creatinine than non-Blacks.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mweir@medicine.umaryland.edu
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Michael A
authors.initials: MA
authors.lastname: Weber
authors.forename: Bjorn
authors.initials: B
authors.lastname: Dahlof
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Roxzana Y
authors.initials: RY
authors.lastname: Kelly
authors.forename: Tsushung A
authors.initials: TA
authors.lastname: Hua
authors.forename: R Allen
authors.initials: RA
authors.lastname: Hester
authors.forename: Eric
authors.initials: E
authors.lastname: Velazquez
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Jamerson
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000503:physiopathology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015854:Up-Regulation
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001552:Benzazepines; D015415:Biomarkers; D002121:Calcium Channel Blockers; D004232:Diuretics; D006852:Hydrochlorothiazide; D017311:Amlodipine; D003404:Creatinine; C044946:benazepril