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Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial.

AbstractBACKGROUND:
Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events.
METHODS:
We randomly assigned 1,094 African Americans with hypertensive nephrosclerosis (glomerular filtration rate [GFR], 20 to 65 mL/min/1.73 m(2) [0.33 to 1.08 mL/s]) to initial antihypertensive treatment with either: (1) a beta-blocker, metoprolol; (2) an angiotensin-converting enzyme inhibitor, ramipril; or (3) a dihydropyridine calcium channel blocker, amlodipine, and either a usual-blood pressure (BP) or low-BP treatment goal. Using a design powered to detect renal outcome differences, we compared the effect of treatment on the CV event rate (cardiac death, myocardial infarction, stroke, and heart failure) during a mean follow-up period of 4.1 years and determined baseline factors that predict CV outcomes.
RESULTS:
Thirty-one patients died of CV disease (0.7%/patient-year), and 149 patients experienced at least 1 CV outcome (3.3%/patient-year). Overall, 202 CV events (4.5%/patient-year) occurred. The CV outcome rate was not related significantly to randomized interventions. In multivariable analyses, 7 baseline risk factors remained independently associated with increased risk for the CV composite outcome after controlling for age, sex, baseline GFR, and baseline proteinuria group: pulse pressure, duration of hypertension, abnormal electrocardiogram result, non-high-density lipoprotein cholesterol level, serum urea nitrogen level, urine protein-creatinine ratio, urine sodium-potassium ratio, and annual income less than 15,000 dollars.
CONCLUSION:
Neither randomized class of antihypertensive therapy nor BP level had a significant effect on the occurrence of CV events, possibly because of limited power. However, this analysis identifies unique and potentially modifiable CV risk factors in this high-risk cohort.
AuthorsKeith Norris, Jacque Bourgoigne, Jennifer Gassman, Lee Hebert, John Middleton, Robert A Phillips, Otelio Randall, Stephen Rostand, Susan Sherer, Robert D Toto, Jackson T Wright Jr, Xuelei Wang, Tom Greene, Lawrence J Appel, Julia Lewis, AASK Study Group
JournalAmerican journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 48 Issue 5 Pg. 739-51 (Nov 2006) ISSN: 1523-6838 [Electronic] United States
PMID17059993 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Creatinine
Topics
  • Adolescent
  • Adrenergic beta-Antagonists (therapeutic use)
  • Adult
  • Black or African American
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
  • Antihypertensive Agents (therapeutic use)
  • Calcium Channel Blockers (therapeutic use)
  • Cardiovascular Diseases (ethnology, etiology, physiopathology)
  • Creatinine (blood)
  • Humans
  • Hypertension (complications, drug therapy, ethnology)
  • Hypertension, Renal (complications, drug therapy, ethnology)
  • Middle Aged
  • Multivariate Analysis
  • Nephrosclerosis (complications, drug therapy, ethnology, etiology)
  • Prognosis
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors

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