(taken directly from the application) Evidence exists suggesting that the incidence of hypertension in African Americans (AA) is markedly and significantly higher than in whites, and that the kidneys of AA are more susceptible to hypertension; and for any given level of blood pressure elevation, the renal circulation in AA may be subjected to a greater injury. Thus, the incidence of end stage renal disease due to hypertension in AA is several times higher than in whites. Indeed every day in Los Angeles, one new AA begins dialysis treatment for renal failure due to hypertension. It is not known whether stricter control of hypertension (MAP less than 92 mmHg) is superior to the usual control of hypertension (MAP 102-107mmHg) in protecting renal function in AA. Further, other data suggest that certain antihypertensive drugs such as angiotensin converting enzyme inhibitors (ACEI) or calcium channel blockers (CCB) may retard progression of renal failure better than other medications. Thus, a controlled study examining the efficacy of these drugs and the impact of two levels of blood pressure control on the progression of renal failure in hypertension AA is needed. The proposed research is a part of a multicenter, prospective, double masked randomized clinical trial examining the effect of three drug regimens (ACEI, CCB and B-blockers) and two different levels of MAP control (less than 92 versus 102-107 mmHg). Thus, the study will follow a three by two factorial design. The outcome of the study will estimate the changes in GFR in a fixed time period among the three treatment arms and the two levels of blood pressure control. The University of Southern California (USC), Martin Luther King-Drew Medical Center (MLK) and Harbor General Hospital-UCLA (HGH) are three major institutions which provide care for renal diseases and hypertension among the one million AA living in Los Angeles. These three institutions have teamed in a consortium during the pilot study of AASK and have been successful in their recruitment efforts. We will continue this consortium for the full scale study and will use our expertise, experience and commitment to bring to successful fruition our part in this multicenter Study.
|Phillips, Robert A; Faulkner, Marquetta; Gassman, Jennifer et al. (2004) Recruitment of African Americans with chronic renal insufficiency into a multicenter clinical trial: the african american study of kidney disease and hypertension. J Clin Hypertens (Greenwich) 6:430-6|
|Lea, Janice P; Brown, Denyse T; Lipkowitz, Michael et al. (2003) Preventing renal dysfunction in patients with hypertension: clinical implications from the early AASK Trial results. Am J Cardiovasc Drugs 3:193-200|
|Norris, Keith C; Agodoa, Lawrence Y (2002) Race and kidney disease: the scope of the problem. J Natl Med Assoc 94:1S-6S|
|Kusek, John W; Greene, Paul; Wang, Shin-Ru et al. (2002) Cross-sectional study of health-related quality of life in African Americans with chronic renal insufficiency: the African American Study of Kidney Disease and Hypertension Trial. Am J Kidney Dis 39:513-24|