American Journal of Cardiovascular Drugs

, Volume 3, Issue 3, pp 193–200

Preventing Renal Dysfunction in Patients with Hypertension

Clinical Implications from the Early AASK Trial Results
  • Janice P. Lea
  • Denyse T. Brown
  • Michael Lipkowitz
  • John Middleton
  • Keith Norris
  • AASK Study Group
Review Article

Abstract

Strategies to delay progression of established renal disease have primarily been directed at examining the class of antihypertensive therapy and/or the level of blood pressure control. In diabetic renal disease many trials have noted a protective role of ACE inhibitor-based therapy over non-ACE inhibitor-based therapy. This paper reviews recent clinical trials evaluating hypertension-related kidney disease including the interim results of the African-American Study of Kidney Diseases and Hypertension (AASK) Study, to date the largest prospective study of African-American patients with kidney disease due to hypertension. This trial reports a renoprotective effect of ACE inhibitor-based therapy over calcium-channel antagonist- based therapy. The renoprotective effect of ACE inhibitor-based therapy may, in part, be due to their antiproteinuric effect independent of blood pressure lowering.

References

  1. 1.
    The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997 Nov 24; 157 (21): 2413-46Google Scholar
  2. 2.
    Jones CA, McQuillan GM, Kusek JW, et al. Serum creatinines in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 1998; 32: 992–9PubMedCrossRefGoogle Scholar
  3. 3.
    Hebert LA, Kusek JW, Greene T, et al. Effects of blood pressure control on progressive renal disease in blacks and whites. Hypertension 1997; 30: 428–35PubMedCrossRefGoogle Scholar
  4. 4.
    UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703–13CrossRefGoogle Scholar
  5. 5.
    Klag MK, Whelton PK, Randall BL, et al. Risk of ESRD in MRFIT screenees. N Engl J Med 1996; 334: 13–8PubMedCrossRefGoogle Scholar
  6. 6.
    Agodoa L, Appel L, Bakris G, et al. for the African-American Study of Kidney Disease and Hypertension (AASK) Study Group. Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis. JAMA 2001; 285: 2719–28PubMedCrossRefGoogle Scholar
  7. 7.
    Freedman BI, Iskander SS, Appel RG. In-depth review: the link between hypertension and nephrosclerosis. Am J Kidney Dis 1995; 25: 207–21PubMedCrossRefGoogle Scholar
  8. 8.
    Schlessinger SD, Tankersley MR, Curtis JJ. Clinical documentation of end-stage renal disease due to hypertension. Am J Kidney Dis 1994; 23: 655–60PubMedGoogle Scholar
  9. 9.
    Weisstuch JM, Dworkin LD. Does essential hypertension cause end-stage renal disease? Kidney Int Suppl 1992; 41: s33–7Google Scholar
  10. 10.
    Caetano ER, Zatz R, Saldanha LB, et al. Hypertensive nephrosclerosis as a relevant cause of chronic renal failure. Hypertension 2001; 38: 171–6PubMedCrossRefGoogle Scholar
  11. 11.
    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. Kidney Int 1997; 51: 244–52PubMedCrossRefGoogle Scholar
  12. 12.
    Ruilope LM, Salvetti A, Jamerson K, et al. Renal function and intensive lowering of blood pressure in hypertensive participants of the Hypertension Optimal Treatment (HOT) Study. J Am Soc Nephrol 2001; 12: 218–25PubMedGoogle Scholar
  13. 13.
    Coresh J, Wei GL, McQuillan G, et al. Prevalence of high blood pressure and elevated serum creatinine level in the united states. Arch Intern Med 2001; 161: 1207–16PubMedCrossRefGoogle Scholar
  14. 14.
    Redon J, Liao Y, Lozano JV, et al. Factors related to the presence of microalbuminuria in essential hypertension. Hypertension 1994; 7: 801–7Google Scholar
  15. 15.
    Jensen JS, Feldt-Rasmussen B, Strandgaard S, et al. Arterial hypertension, microalbuminuria, and risk of ischemic heart disease. Hypertension 2000; 35: 898–903PubMedCrossRefGoogle Scholar
  16. 16.
    Culleton BF, Larson MG, Wilson PWF, et al. Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 1999; 56: 2214–9PubMedCrossRefGoogle Scholar
  17. 17.
    Agrawal B, Berger A, Wolf K, et al. Microalbuminuria screening by reagent strip predicts cardiovascular risk in hypertension. J Hypertens 1996; 14: 223–8PubMedCrossRefGoogle Scholar
  18. 18.
    Shulman NB, Ford CE, Hall WD, et al. Prognostic value of serum creatinine and effect of treatment of hypertension on renal function: results from the hypertension, detection, and follow-up program. Hypertension 1989; 13: I80–93PubMedCrossRefGoogle Scholar
  19. 19.
    Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensin-convertingenzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: 1456–62PubMedCrossRefGoogle Scholar
  20. 20.
    Ravid M, Lang R, Rachmani R, et al. Long-termrenoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus: a 7 year follow-up study. Arch Intern Med 1996; 156: 286–9PubMedCrossRefGoogle Scholar
  21. 21.
    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. N Engl J Med 1994; 330: 877–84PubMedCrossRefGoogle Scholar
  22. 22.
    Maschio G, Alberti D, Janin G, et al. Effect of the angiotensin-converting enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med 1996; 334: 939–45PubMedCrossRefGoogle Scholar
  23. 23.
    Randomized placebo controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997; 349: 1857-63Google Scholar
  24. 24.
    Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low- dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351: 1755–62PubMedCrossRefGoogle Scholar
  25. 25.
    Toto RD, Mitchell HC, Smith RD, et al. ’strict’ blood pressure control and progression of renal disease in hypertensive nephrosclerosis. Kidney Int 1995; 48: 851–9PubMedCrossRefGoogle Scholar
  26. 26.
    Rostand SG, Brown G, Kirk K, et al. Renal insufficiency in treated essential hypertension. N Engl J Med 1989; 320: 684–8PubMedCrossRefGoogle Scholar
  27. 27.
    Segura J, Campo C, Rodicio J, et al. ACE inhibitors and appearance of renal events in hypertensive nephrosclerosis. Hypertension 2001; 38: 645–9PubMedCrossRefGoogle Scholar
  28. 28.
    Ruilope LM, Alcazar JM, Hernandez E, et al. Long-term influences of antihypertensive therapy on microalbuminuria in essential hypertension. Kidney Int 1994; 45: S171–3Google Scholar
  29. 29.
    Lea JP, Contreras G, Kopple JD, et al. The use of diuretic therapy in achievement of blood pressure goals in the African-American study of kidney disease and hypertension [abstract]. J Am Soc Nephrol 2001; 12: A2515Google Scholar
  30. 30.
    Estacio RO, Jeffers BW, Hiatt WR, et al. The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 1998; 338(10): 645–52PubMedCrossRefGoogle Scholar
  31. 31.
    Peters H, Border WA, Noble NA. Targeting TGF-β overexpression in renal disease: maximizing the antifibrotic action of angiotensin II blockade. Kidney Int 1998; 54: 1570–80PubMedCrossRefGoogle Scholar
  32. 32.
    Epstein M. Aldosterone as a mediator of progressive renal disease: pathogenetic and clinical implications. Am J Kidney Dis 2001; 37: 677–88PubMedCrossRefGoogle Scholar
  33. 33.
    Romero JC, Reckelhoff JF. Role of angiotensin II and oxidative stress in essential hypertension. Hypertension 1999; 34: 943–9PubMedCrossRefGoogle Scholar
  34. 34.
    Johnson DW. Growth factors in progressive renal disease. Nephrology 2000; 5: 251–61CrossRefGoogle Scholar
  35. 35.
    Fogo AB. Progression and potential regression of glomerulosclerosis. Kidney Int 2001; 59: 804–19PubMedCrossRefGoogle Scholar
  36. 36.
    Wright JT, Bakris G, Greene T, et al. forme AASK Study Group. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002; 288: 2421–31PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  • Janice P. Lea
    • 1
  • Denyse T. Brown
    • 2
  • Michael Lipkowitz
    • 3
  • John Middleton
    • 4
  • Keith Norris
    • 5
  • AASK Study Group
  1. 1.Emory University School of MedicineAtlantaUSA
  2. 2.University of Alabama at BirminghamBirminghamUSA
  3. 3.Mount Sinai School of MedicineNew YorkUSA
  4. 4.University of Texas-SouthwesternDallasUSA
  5. 5.Martin Luther KingJr/Charles Drew UniversityLos AngelesUSA

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