There is a disproportionate number of African Americans with hypertension and end-stage renal disease (ESRD) secondary to hypertension. Hypertension is the leading cause of ESRD in African Americans. Despite this, there is little data addressing potential therapeutic maneuvers which may slow or halt development of hypertensive ESRD in this patient population. The goal of this project is to conduct a multi-center study to determine if angiotensin-converting enzyme inhibitors (CEI), calcium channel blockers (CCB) or beta blockers (BB) protect the kidney from progressive damage in African Americans with hypertensive nephrosclerosis and to determine if lowering blood pressure and achieving blood pressure goals considerably below the currently recommended mean arterial blood pressure (MAP) of 107 might slow the rate of decline of renal function in this patient population. The proposed experimental design is a multi- center randomized prospective controlled double masked study. Only African Americans with hypertensive nephrosclerosis and no other major medical illnesses will be enrolled. Following a series of screening tests, patients will be randomized to either receive CEI, CCB, or BB, and other anti-hypertensives as needed to achieve either a MAP goal between 102-107 mm/Hg or less than or equal to 92 mm/Hg. Non-pharmacologic therapeutic interventions will be monitored in all patients. Patients will have monthly clinic visits with quarterly laboratory evaluations. Patients' renal function, the major outcome variable, will be evaluated by measuring glomerular filtration rate (GFR) (Iothalamate). Stop points including: halving initial renal function, uncontrolled blood pressure, or adverse events. This center participated in the pilot study for this trial and was active in the development and implementation of the AASK protocol.
