Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial.
Abstract | BACKGROUND: 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.
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Authors | Keith 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 |
Journal | American 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 |
PMID | 17059993
(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.)
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Chemical References |
- Adrenergic beta-Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Antihypertensive Agents
- Calcium Channel Blockers
- Creatinine
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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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