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

Lawrence J. Appel, Jackson T. Wright, Tom Greene, John W. Kusek, Julia B. Lewis, Xuelei Wang, Michael S. Lipkowitz, Keith C. Norris, George L. Bakris, Mahboob Rahman, Gabriel Contreras, Stephen G. Rostand, Joel D. Kopple, Francis B. Gabbai, Gerald I. Schulman, Jennifer J. Gassman, Jeanne Charleston, Lawrence Y. Agodoa

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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 β-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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)832-839
Number of pages8
JournalArchives of internal medicine
Volume168
Issue number8
DOIs
StatePublished - Apr 28 2008

ASJC Scopus subject areas

  • Internal Medicine

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    Appel, L. J., Wright, J. T., Greene, T., Kusek, J. W., Lewis, J. B., Wang, X., Lipkowitz, M. S., Norris, K. C., Bakris, G. L., Rahman, M., Contreras, G., Rostand, S. G., Kopple, J. D., Gabbai, F. B., Schulman, G. I., Gassman, J. J., Charleston, J., & Agodoa, L. Y. (2008). 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. Archives of internal medicine, 168(8), 832-839. https://doi.org/10.1001/archinte.168.8.832