Effects of Blood Pressure Control on Progressive Renal Disease in Blacks and Whites

Abstract

African Americans (blacks) have a disproportionately high incidence of end-stage renal disease due to hypertension. The Modification of Diet in Renal Disease (MDRD) Study found that strict blood pressure control slowed the decline in glomerular filtration rate (GFR) only in the subgroup of patients with proteinuria. The present report compares the effects of blood pressure control in black and white MDRD Study participants. Fifty-three black and 495 white participants with baseline GFRs of 25 to 55 mL/min/1.73 m2 were randomly assigned to a usual or low mean arterial pressure (MAP) goal of < or = 107 or < or = 92 mm Hg, respectively. GFR decline was compared between randomized groups and correlated with the level of achieved blood pressure. The mean (+/-SE) GFR decline over 3 years in the low blood pressure group was 11.8+/-7.3 mL/min slower than in the usual blood pressure group among blacks (P=.11) compared with 0.3+/-1.3 mL/min slower among whites (P=.81) (P=.12 between blacks and whites). In both blacks and whites, higher baseline urine protein excretion was associated with a greater beneficial effect of the low MAP goal on GFR decline (P=.02 for both races). Combining both blood pressure groups and controlling for baseline characteristics, higher follow-up achieved MAP was associated with faster GFR decline in both blacks (P<.001) and whites (P=.002), with a sevenfold stronger relationship in blacks (P<.001). These secondary analyses support the prior recommendation for a lower than usual blood pressure goal (MAP < or = 92 mm Hg) in black and white patients with proteinuria (> 1 g/d). In addition, a lower level of blood pressure control may be even more important in blacks than in whites in slowing the progression of renal disease.

Management of Uncontrolled Hypertension in a Nurse-Led Clinic Compared With Conventional Care for Patients with Type 2 Diabetes

“…A target of Ͻ135/75 mmHg is recommended by the National Institutes of Clinical Excellence (17). Moreover, data from the Modification of Diet in Renal Disease Study Group suggest an even lower target BP of Ͻ120/70 mmHg to limit progressive renal disease (25). In our study, the level of albuminuria was unaffected by BP lowering.…”

Antihypertensive efficacy and safety of olmesartan medoxomil compared with amlodipine for mild-to-moderate hypertension

“…This is particularly important in light of evidence that lower BP goals have been shown to provide greater cardiovascular and renal benefits in numerous clinical trials in patients with diabetes and renal disease. [24][25][26] In addition to demonstrating the superior rate of BP goal achievement with olmesartan medoxomil, this study demonstrated that numerically fewer reported oedema-related AEs were associated with olmesartan medoxomil compared with amlodipine when both drugs are administered at the recommended starting doses. It has been well established that many patients require dose titration in order to reach an appropriate BP target.…”

What Are Optimal Blood Pressure Targets for Patients with Hypertension and Chronic Kidney Disease?

“…Thus, low BP treatment goal showing greater benefit in those with proteinuria exceeding 3g per day at baseline, moderate in those with proteinuria between 1 and 3g per day, and no benefit in those with proteinuria of less than 1g per day [7]. These post hoc analysis findings led to the Post hoc analysis suggested that a lower BP target might be more effective in preventing renal disease progression in black versus white patients [9] and that blacks have higher nocturnal BP and may benefit from greater nocturnal BP lowering [10]. Furthermore, a follow up analysis of the MDRD cohort for 7 years revealed fewer ESRD or combined ESRD and death events in the more aggressive BP lowering group [11].…”