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. Despite excellent blood pressure control and despite use of reno-protective antihypertensive medication, hypertension-related renal disease commonly progresses. The factors that determine the progression of this determine prospectively the long-term course of kidney function and risk factors for kidney disease progression in African-Americans with hypertension-related kidney disease that receive recommended antihypertensive 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. 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 antihypertensive therapy (ramipril, metoprolol and amlodipine) and 2 levels of blood pressure control (usual control and more aggressive control). Of the 1,094 randomized participants in AASK, it is anticipated that 650-750 individuals who have not reached ESRD will enroll in the Cohort Study. In addition, those individuals who reached ESRD during the AASK trial will be invited to attend one visit for collection of DNA. For those who enroll in the Cohort Study, twice each year, approximately every 6 months, exposures will be collected. Exposures will include environmental, genetic, physiologic, and socio-economic factors. The primary renal outcome will be a clinical outcome defined by doubling of serum creatinine, ESRD or death. Appropriate antihypertensive treatment (medications and target BP level as determined in the AASK trial) will be provided to all participants who 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 medication) and will therefore address its research objectives in the setting of recommended antihypertensive care. We anticipate a minimum of 4 contacts and maximum of 6 contacts for BP control per participant per year. The anticipated duration of follow-up in the Cohort Study will be 5 years (total of 9-12 years, including the period of the AASK trial). It is anticipated that the AASK Cohort Study will provide data that enhance 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.
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