Hypertension is one of the major causes of end stage renal disease (ESRD) in the general population, and the number one cause in blacks. These two diseases are the major causes of morbidity and mortality in the United States, especially among African Americans. There is some preliminary evidence suggesting that some antihypertensive drugs may retard the progression of hypertensive renal disease but, no clinical trial has been conducted to test this hypothesis in African Americans, who are disproportionately affected by this ailment. This multicenter project will compare the effects of two levels of blood pressure control and three different antihypertensive drug regimens on the rate of decline in glomerular filtration rate (GFR) in hypertensive African Americans 18-70 years of age, with clinically diagnosed hypertensive renal disease (GFR of 25-70ml/min/1.73m sq.) to try to find answers to: 1) Is the pathological lesion in hypertensive renal disease purely a result of persistent hypertension? 2) Is one antihypertensive drug better than another in terms of preservation of renal function? 3) Is there a level of blood pressure (BP) more suitable for the survival of the kidney as opposed to the generally recommended level of 140/90mmHg? Those who qualify, based on BP levels and GFR results, will then be randomized, in a 3x2 factorial design to initial treatment with either an angiotensin converting enzyme inhibitor (enalapril), a calcium channel blocker (amlodipine), or a beta- blocker (atenolol) and to a mean arterial BP (goal MAP) of either =/< 92mmHg or 102-107mmHg. Furosemide, doxazosin, clonidine, hydralazine, and minoxidil are added, sequentially, until goal MAP is achieved.
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