Effect of Ramipril vs Amlodipine on Renal Outcomes in Hypertensive Nephrosclerosis&lt;SUBTITLE&gt;A Randomized Controlled Trial&lt;/SUBTITLE&gt;

Agodoa, Lawrence Y.; Appel, Lawrence J.; Bakris, George L.; Beck, Gerald J.; Bourgoignie, Jacque; Briggs, Josephine P.; Charleston, Jeanne; DeAnna, C.; Cleveland, W. H.; Douglas, Janice G.; Douglas, M.; Dowie, Donna; Faulkner, Marquetta; Gabriel, Avril; Gassman, Jennifer; Greene, Tom; Hall, Yvette; Hebert, Lee A.; Hiremath, Leena; Jamerson, Kenneth; Johnson, Carolyn J.; Kopple, Joel D.; Kusek, John W.; Lash, James P.; Lea, Janice P.; Lewis, Julia B.; Lipkowitz, Michael S.; Massry, Shaul G.; Middleton, John; Miller, Edgar R.; Norris, Keith C.; O’Connor, Daniel T.; Ojo, Akinlou; Phillips, Robert A.; Pogue, Velvie A.; Rahman, Mahboob; Randall, Otelio S.; Rostand, Stephen G.; Schulman, Gerald; Smith, W. G. J.; Thornley‐Brown, Denyse; Tisher, C. Craig; Toto, Robert D.; Wright, Jackson T.; Xu, Sheng

doi:10.1001/jama.285.21.2719

Cited by 854 publications

(521 citation statements)

References 39 publications

(76 reference statements)

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“…In addition, cross-sectional studies have shown that increased SBV is associated with increased renal resistive index, a marker of renal arteriosclerosis (6). Despite these potential mechanisms linking SBV with renal disease, SBV was not independently associated with renal events in our study, principally after controlling for proteinuria, which has been demonstrated in hypertensive individuals to be predictive of renal outcomes (15,(29)(30)(31)(32). In our analyses, the HRs for cardiovascular and renal events from highest compared with the lowest tertile of SBV decreased from 2.81 to 1.43 and 1.58 to 1.29, respectively, upon adjusting for log proteinuria.…”

Section: Discussioncontrasting

confidence: 73%

“…Individuals were assigned in a 2:2:1 distribution to metoprolol, ramipril, and amlodipine, respectively, and in a 1:1 distribution to usual and low BP goals, consistent with the overall AASK trial population (15,16,17). Participants assigned to receive amlodipine had lower SBV than those assigned to either ramipril or metoprolol.…”

Section: Resultsmentioning

confidence: 99%

“…Cardiovascular events were a composite consisting of cardiovascular death, cardiovascular revascularization, nonfatal myocardial infarction (MI), hospitalization for heart failure, or stroke as described in detail elsewhere (14). Renal events were a composite consisting of ESRD, a reduction in GFR by $50% relative to mean of two baselines measurements, a decline in GFR of $25 ml/ min per 1.73 m 2 from baseline, or death (15).…”

Section: Endpointsmentioning

confidence: 99%

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Association of BP Variability with Mortality among African Americans with CKD

McMullan

Bakris

Phillips

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Increased systolic BP visit-to-visit variability (SBV) may be associated with higher overall mortality and cardiovascular events. However, few studies have examined these associations in patients with CKD, and the relation of SBV with CKD progression and ESRD has not been shown. This study analyzed the association of SBV with overall mortality, cardiovascular mortality, cardiovascular events, and renal events among individuals enrolled in the African American Study of Kidney Disease (AASK) trial.Design, setting, participants, & measurements This was a prospective observational study of 908 participants during the trial phase of the AASK study, with at least 1 year of BP measurements available and followed for 3-6.4 years. SBV was calculated as the SD of the systolic pressure from five visits occurring 3-12 months after randomization. The association of SBV with risk of overall mortality, cardiovascular mortality, a composite of fatal and nonfatal cardiovascular events, and a composite of renal events was assessed using proportional hazards regression and adjusting for multiple potential confounders.Results Greater SBV was associated with higher overall mortality. The adjusted hazard ratio (95% confidence interval) was 2.82 (1.14-6.95) comparing the highest with lowest tertile of SBV. A similar comparison revealed that greater SBV was also associated with cardiovascular mortality (adjusted hazard ratio, 4.91; 1.12-21.50). SBV was associated with both the cardiovascular renal composite endpoints in unadjusted but not adjusted analyses.Conclusions In African Americans with CKD, SBV is strongly and independently associated with overall and cardiovascular mortality.

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Section: Discussioncontrasting

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Section: Endpointsmentioning

confidence: 99%

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Association of BP Variability with Mortality among African Americans with CKD

McMullan

Bakris

Phillips

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…The recent interim analysis of the AfricanAmerican Study of Kidney Disease (AASK) trial provides important insights regarding the therapeutic selections and clinical characteristics influencing preservation of kidney function in African-Americans who have reduced kidney function attributable to hypertensive nephrosclerosis [74]. AASK was a 3 Â 2 factorial design trial that randomized 1094 African-Americans with glomerular filtration rates (GFR) between 20 and 65 mL/min/1.…”

Section: Treatmentmentioning

confidence: 99%

“…If BP elevations, the reduction in kidney function, or both are severe, a reduction in BP after initiation of pharmacologic therapy, even if ACE inhibitors or angiotensin receptor blockers are not used, will likely cause a transient rise in creatinine. ACE inhibitors initially cause a measurable fall in GFR [74]; however, over the long term, these agents markedly slow the progressive loss in kidney function. Bakris and Weir [86], in their excellent review of the subject, point out that the major reason for a rise in creatinine after initiation of ACE inhibitor therapy is volume depletion attributable to overdiuresis.…”

Section: Kidney Function Changes With Treatmentmentioning

confidence: 99%

Hypertension in special populations

Flack

Peters

Mehra

et al. 2003

Current Problems in Cardiology

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Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults

Psaty¹,

Manolio²,

Smith³

et al. 2002

Arch Intern Med

131

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While control of high BP improved in the 1990s, about half the participants with hypertension had uncontrolled BP, primarily mild to moderate elevations in systolic BP. Low-dose diuretics and beta-blockers--the preferred agents since 1993 according to the recommendations of the Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure--remained underused. More widespread use of these agents will be an important intervention to prevent the devastating complications of hypertension, including stroke, myocardial infarction, and heart failure.

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Effect of Ramipril vs Amlodipine on Renal Outcomes in Hypertensive Nephrosclerosis<SUBTITLE>A Randomized Controlled Trial</SUBTITLE>

Abstract: Ramipril, compared with amlodipine, retards renal disease progression in patients with hypertensive renal disease and proteinuria and may offer benefit to patients without proteinuria.

Cited by 854 publications

References 39 publications

Association of BP Variability with Mortality among African Americans with CKD

Association of BP Variability with Mortality among African Americans with CKD

Hypertension in special populations

Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults

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