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Blood pressure control, drug therapy, and kidney disease.
Hypertension. 2005 Jul; 46(1):44-50.H

Abstract

The African American Study of Kidney Disease and Hypertension examined the effect on renal function decline of 2 blood pressure (BP) goals (low mean arterial pressure [MAP] < or =92 versus usual MAP 102 to 107 mm Hg) and 3 antihypertensives (ramipril versus amlodipine versus metoprolol). We previously reported that in all drug groups combined the BP intervention had similar effects on the primary outcome of glomerular filtration rate (GFR) slope or the main secondary clinical composite outcome of end-stage renal disease (ESRD), death, or GFR decline by 50% or 25 mL/min per 1.73 m2. This report examines the effect of the BP intervention separately in the 3 drug groups. The BP effect was similar among the drug groups for either GFR slope or the main clinical composite. However, the BP effect differed significantly among the drug groups for the composite of ESRD or death (P=0.035) and ESRD alone (P=0.021). Higher event rates for amlodipine patients assigned to the usual BP goal (0.087 per patient-year for ESRD or death and 0.064 per patient-year for ESRD) were seen compared with the remaining groups of the factorial design (range, 0.041 to 0.050 for ESRD or death; and range, 0.027 to 0.036 for ESRD). The low BP goal was associated with reduced risk of ESRD or death (risk reduction 51%; 95% confidence interval, 13% to 73%) and ESRD (54%; 8% to 77%) for amlodipine patients, but not for patients assigned to the other drug groups. These secondary analyses suggest a benefit of the low BP goal among patients assigned to amlodipine, but they must be interpreted cautiously.

Authors+Show Affiliations

University of Miami, Miami, FL, USA. gcontrer@med.miami.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15897360

Citation

Contreras, Gabriel, et al. "Blood Pressure Control, Drug Therapy, and Kidney Disease." Hypertension (Dallas, Tex. : 1979), vol. 46, no. 1, 2005, pp. 44-50.
Contreras G, Greene T, Agodoa LY, et al. Blood pressure control, drug therapy, and kidney disease. Hypertension. 2005;46(1):44-50.
Contreras, G., Greene, T., Agodoa, L. Y., Cheek, D., Junco, G., Dowie, D., Lash, J., Lipkowitz, M., Miller, E. R., Ojo, A., Sika, M., Wilkening, B., & Toto, R. D. (2005). Blood pressure control, drug therapy, and kidney disease. Hypertension (Dallas, Tex. : 1979), 46(1), 44-50.
Contreras G, et al. Blood Pressure Control, Drug Therapy, and Kidney Disease. Hypertension. 2005;46(1):44-50. PubMed PMID: 15897360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood pressure control, drug therapy, and kidney disease. AU - Contreras,Gabriel, AU - Greene,Tom, AU - Agodoa,Lawrence Y, AU - Cheek,DeAnna, AU - Junco,George, AU - Dowie,Donna, AU - Lash,James, AU - Lipkowitz,Michael, AU - Miller,Edgar R,3rd AU - Ojo,Akinlou, AU - Sika,Mohammed, AU - Wilkening,Beth, AU - Toto,Robert D, AU - ,, Y1 - 2005/05/16/ PY - 2005/5/18/pubmed PY - 2005/12/13/medline PY - 2005/5/18/entrez SP - 44 EP - 50 JF - Hypertension (Dallas, Tex. : 1979) JO - Hypertension VL - 46 IS - 1 N2 - The African American Study of Kidney Disease and Hypertension examined the effect on renal function decline of 2 blood pressure (BP) goals (low mean arterial pressure [MAP] < or =92 versus usual MAP 102 to 107 mm Hg) and 3 antihypertensives (ramipril versus amlodipine versus metoprolol). We previously reported that in all drug groups combined the BP intervention had similar effects on the primary outcome of glomerular filtration rate (GFR) slope or the main secondary clinical composite outcome of end-stage renal disease (ESRD), death, or GFR decline by 50% or 25 mL/min per 1.73 m2. This report examines the effect of the BP intervention separately in the 3 drug groups. The BP effect was similar among the drug groups for either GFR slope or the main clinical composite. However, the BP effect differed significantly among the drug groups for the composite of ESRD or death (P=0.035) and ESRD alone (P=0.021). Higher event rates for amlodipine patients assigned to the usual BP goal (0.087 per patient-year for ESRD or death and 0.064 per patient-year for ESRD) were seen compared with the remaining groups of the factorial design (range, 0.041 to 0.050 for ESRD or death; and range, 0.027 to 0.036 for ESRD). The low BP goal was associated with reduced risk of ESRD or death (risk reduction 51%; 95% confidence interval, 13% to 73%) and ESRD (54%; 8% to 77%) for amlodipine patients, but not for patients assigned to the other drug groups. These secondary analyses suggest a benefit of the low BP goal among patients assigned to amlodipine, but they must be interpreted cautiously. SN - 1524-4563 UR - https://www.unboundmedicine.com/medline/citation/15897360/Blood_pressure_control_drug_therapy_and_kidney_disease_ L2 - https://www.ahajournals.org/doi/10.1161/01.HYP.0000166746.04472.60?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -