Current Hypertension Reports

, Volume 7, Issue 5, pp 363–366 | Cite as

The African American Study of Kidney Disease: Do these results indicate that 140/90 mm Hg is good enough?

  • Mahboob Rahman
  • Ashraf El-Meanawy
  • Joseph Romanello
Article

Abstract

Current national guidelines recommend aggressive lowering of blood pressure (< 130/80 mm Hg) in patients with chronic kidney disease (CKD). In this paper, we summarize recent clinical trial data evaluating the effect of lower blood pressure goals on renal outcomes. The epidemiologic data relating blood pressure to progression of kidney disease, the Modification of Diet in Renal Disease (MDRD) study (in patients with > 1 g proteinuria/d), and meta-analyses of angiotensin-converting enzyme (ACE) inhibitor clinical trials all support lower blood pressure goals in CKD patients, particularly those with proteinuria. The African American Study of Kidney Disease and Hypertension (AASK) supports lower blood pressure goals in terms of reduction of proteinuria, but demonstrates no additional benefit for clinical renal outcomes. Similarly, the second Ramipril Efficacy in Nephropathy study (REIN-2) shows that in patients with proteinuric nondiabetic renal disease who are receiving ACE inhibitors, a lower than usual blood pressure goal does not improve renal outcomes. However, there are limited clinical trial data evaluating the effects of low blood pressure on the increased cardiovascular risk seen in patients with CKD. Pending further clinical studies, current recommendations to target tight blood pressure control (< 130/80 mm Hg) in patients with CKD appear reasonable.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Kidney Disease Outcomes Quality Initiative: K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004, 43:S1-S290.Google Scholar
  2. 2.
    Kidney Disease Outcomes Quality Initiative: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 39:S1-S246.CrossRefGoogle Scholar
  3. 3.
    Sarnak MJ, Levey AS, Schoolwerth AC, et al.: Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003, 42:1050–1065.PubMedCrossRefGoogle Scholar
  4. 4.
    Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.PubMedCrossRefGoogle Scholar
  5. 5.
    Klag MJ, Whelton PK, Randall BL, et al.: Blood pressure and end-stage renal disease in men. N Engl J Med 1996, 334:13–18.PubMedCrossRefGoogle Scholar
  6. 6.
    Rahman M, Brown CD, Coresh J, et al.: The prevalence of reduced glomerular filtration rate in older hypertensive patients and its association with cardiovascular disease: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Arch Intern Med 2004, 164:969–976. This study demonstrates that the prevalence of reduced GFR is high in older hypertensive patients. Reduced GFR is independently associated with prevalent CVD and LVH.PubMedCrossRefGoogle Scholar
  7. 7.
    Klahr S, Levey AS, Beck GJ, et al.: The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med 1994, 330:877–884.PubMedCrossRefGoogle Scholar
  8. 8.
    Wright JT Jr, Bakris G, Greene T, et al.: Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002, 288:2421–2431. This prospective multicenter clinical trial in African Americans with hypertensive nephrosclerosis demonstrated that tight blood pressure control resulted in reduction in proteinuria, but no benefit was seen with regard to other renal outcomes.PubMedCrossRefGoogle Scholar
  9. 9.
    Fogo A, Breyer JA, Smith MC, et al.: Accuracy of the diagnosis of hypertensive nephrosclerosis in African Americans: a report from the African American Study of Kidney Disease (AASK) Trial. AASK Pilot Study Investigators. Kidney Int 1997, 51:244–252.PubMedCrossRefGoogle Scholar
  10. 10.
    Hirschberg R, Wang S: Proteinuria and growth factors in the development of tubulointerstitial injury and scarring in kidney disease. Curr Opin Nephrol Hypertens 2005, 14:43–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Sarnak MJ, Greene T, Wang X, et al.: The effect of a lower target blood pressure on the progression of kidney disease: longterm follow-up of the modification of diet in renal disease study. Ann Intern Med 2005, 142:342–351. This is a long-term follow-up of participants in the MDRD clinical trial and demonstrates that participants assigned to the lower blood pressure goal were less likely to develop end-stage renal disease than were those assigned to conventional blood pressure goals in the clinical trial.PubMedGoogle Scholar
  12. 12.
    Jafar TH, Schmid CH, Landa M, et al.: Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease: a meta-analysis of patient-level data. Ann Intern Med 2001, 135:73–87.PubMedGoogle Scholar
  13. 13.
    Ruggenenti P, Perna A, Loriga G, et al.: Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial. Lancet 2005, 365:939–946.PubMedCrossRefGoogle Scholar
  14. 14.
    Schrier R, McFann K, Johnson A, et al.: Cardiac and renal effects of standard versus rigorous blood pressure control in autosomal-dominant polycystic kidney disease: results of a seven-year prospective randomized study. J Am Soc Nephrol 2002, 13:1733–1739.PubMedCrossRefGoogle Scholar
  15. 15.
    Foley RN, Murray AM, Li S, et al.: Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999. J Am Soc Nephrol 2005, 16:489–495.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Mahboob Rahman
    • 1
  • Ashraf El-Meanawy
    • 1
  • Joseph Romanello
    • 1
  1. 1.Division of Nephrology and Hypertension, Case Western Reserve UniversityUniversity Hospitals of ClevelandClevelandUSA

Personalised recommendations