(taken directly from the application) The broad objective of this proposal is to assess the effects of sustained reductions in arterial pressure on the progression of renal disease in African-Americans.
The specific aims of this proposal are to assess whether the level of blood pressure reduction affects the progression of renal disease in African-American patients with pre- existing hypertensive renal disease. Hypothesis: Reductions in mean arterial pressure (MAP) to less than 92 mmHg will slow progression of renal disease to a greater extent than higher pressures. 2) To assess whether the class of antihypertensive agent used to achieve a certain level of blood pressure reduction has an effect on preserving renal function independent of arterial pressure reduction. Hypothesis: Certain classes of antihypertensive agents such as converting enzyme inhibitors will slow progression of renal disease independent of their effects on blood pressure reduction. The design of the trial is randomized, prospective, double blind, double dummy. The study population sought is African-Americans with varying degrees of renal insufficiency and modest amounts of proteinuria. One third of these subjects should be female. After screening and randomization to a given class of antihypertensive medications and goal MAP level, subjects will have follow-up every three months, over at least a four year period not to exceed six years. These three month visits will include measurements of glomerular filtration rate, 24 hour urine for protein, urea and electrolytes, blood chemistries and complete blood counts. Hopefully this study will provide data that will subsequently enable physicians to optimize the management and care of African-Americans with hypertension. This will ideally lead to a slowed progression of renal disease in this high risk population and should ultimately reduce morbidity from end stage renal disease and dialysis.
