This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The AASK Cohort Study is a prospective, observational study that is an extension of the AASK Clinical trial. The AASK trial was a randomized, clinical trial that tested the effects of 3 different medications used as first line hypertensive therapy (ramipril, metoprolol and amlodipine) and 2 levels of BP control (usual and more aggressive control). Of the 1,094 randomized participants in AASK, it is estimated that Howard University will enroll 29 (of the 657-750 individuals who did not reach ESRD in the AASK Clinical Trial) in the AASK Cohort Study. Additionally, those AASK participants who reached ESRD will be invited to attend one visit for collection of DNA. Exposures to be collected twice/year for those in the AASK Cohort Study include environmental, genetic, physiologic and socioeconomic factors. The primary renal outcome will be a clinical outcome defined by the doubling of serum creatinine, progression to ESRD or death. Appropriate antihypertensive treatment (medications and target BP levels as determined by the AASK trial) will be provided to all participants who do not have ESRD. In this fashion, the Cohort will directly control two of the major 'known' determinants of kidney disease progression (treatment of hypertension and use of reno-protective, antihypertensive medications) and will, therefore, address its research objectives in the setting of recommended hypertensive care. It is anticipated that a minimum of 4 and a maximum of 6 contacts for BP control will take place per year for each participant. The anticipated duration of followup in the Cohort Study will be 5 years (total of 9-12 years, including the AASK Trial), and that the AASK Cohort Study will provide data that enhances our understanding of the processes that determine progression of renal disease. Furthermore, data from this study might ultimately lead to new prevention strategies that delay or prevent the onset of ESRD. Despite excellent BP control and use of reno-protective antihypertensive medication, hypertension-related renal disease commonly progresses. The primary objective of the AASK Cohort Study is to prospectively determine the long-term course of kidney function and risk factors for kidney disease progression in African Americans with hypertension-related kidney disease who receive recommended antihypertension therapy. A secondary objective is to determine the occurrence of cardiovascular disease and assess its risk factors in the setting of hypertension-related kidney disease.
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