Effect of Blood Pressure Lowering and Antihypertensive Drug Class on Progression of Hypertensive Kidney Disease<SUBTITLE>Results From the AASK Trial</SUBTITLE>

Abstract

No additional benefit of slowing progression of hypertensive nephrosclerosis was observed with the lower BP goal. Angiotensin-converting enzyme inhibitors appear to be more effective than beta-blockers or dihydropyridine calcium channel blockers in slowing GFR decline.

US Hypertension Management Guidelines: A Review of the Recent Past and Recommendations for the Future

“…The evidence for these recommendations is based on 3 trials—the African American Study of Kidney Disease and Hypertension (AASK), the Modification of Diet in Renal Disease (MDRD) study, and the Blood‐pressure Control for Renoprotection in Patients with Non‐diabetic Chronic Renal Disease (REIN‐2) study. None of these trials showed a difference in kidney or CVD outcomes between those with lower versus higher BP goals 40, 41, 42…”

“…While the lower‐BP group achieved an average BP of 128/78 mm Hg, compared with 141/85 mm Hg in the other group, there was no significant change in the rate of glomerular filtration rate decline, end‐stage renal disease, or death. There was, however, a decrease in proteinuria in the strict treatment group at 6 months (17% decrease versus 7% increase), and this effect persisted throughout the length of the study 41. MDRD (N=1585) used the same MAP targets, and in participants with at least 1 g/d of proteinuria, the lower BP target group had a slower rate of glomerular filtration rate decline 42…”

Antihypertensive Therapy in Non-Diabetic Chronic Kidney Disease Associated with Proteinuria in Adults

“…Monotherapy with a calcium channel blocker or a diuretic may be superior in this population than ACE-I. The African American Study of Kidney Disease and Hypertension (AASK trial) [14] included 1094 African American patients with hypertensive renal disease. Mean GFR was 46 ml/min (range 20-65 mL/min per 1.73 m 2 ) and mean protein excretion was about 600 mg/day in men and 400 mg/day in women.…”

Prescribing Patterns and Cost of Antihypertensive Drugs in Private Hospitals in Dar es Salaam, Tanzania

“…In 2002, a clinical trial comparing different classes of antihypertensive medications for initial therapy found that chlorthalidone, a thiazide diuretic, was as effective as other agents in reducing coronary heart disease, death and non fatal myocardial infarction. The drug was superior to amlodipine in preventing heart failure and to lisinopril in preventing stroke [6]. Selection of antihypertensive agents should therefore be based primarily on the comparative ability to prevent these complications.…”