African American Study of Kidney Disease

O'Connor, Daniel

Abstract

(taken directly from the application) Not only is the prevalence (and severity) of hypertension increased in the African-American population, but also the tendency of the kidney to suffer end organ consequences of hypertension, ultimately leading to an increased prevalence of end stage renal disease requiring dialysis or transplantation. Some studies suggest that more severe hypertensive nephrosclerosis in the African-American kidney may not simply be a function of increased severity or duration of hypertension, but may instead reflect differences in the proclivity of this target organ to hypertensive damage. Indeed, some degree of progression of renal dysfunction may occur in African-American hypertensive even with conventionally adequate pharmacologic control of systemic hypertension. It is conceivable (though yet unproven) that some particular antihypertensive regimen would have a preferentially beneficial effect on the kidney in this population, or that a markedly increased intensity of treatment with a lower than usual goal blood pressure, would be beneficial. These hypotheses remain untested, however. This multi-center cooperative antihypertensive trial will test whether the long-term course of decline in renal function in the African-American hypertensive-(entry diastolic blood pressure greater than 95 mmHg) responds preferentially and beneficially to one of three different initial antihypertensive regimens (angiotensin converting enzyme inhibitor versus calcium channel blocker versus beta adrenergic antagonist) at two different treatment intensities, as defined by goal mean arterial blood pressures of 102-107 versus less than 92 mmHg.