|
AASK
African American Study of Kidney disease and hypertension
 |
Author(s) |
(a) Agodoa LY, Appel L, Bakris GL, Beck G, Bourgoignie J, Briggs JP et al
(b) Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, Douglas-Baltimore JG, Gassman J, Glassock R, Hebert L, Jamerson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostand SG
|
 |
Title(s) |
(a) Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis
(b) Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease
|
|
Reference(s) |
(a) JAMA 2001;285:2719-28
(b) JAMA 2002;288:2421-31 |
|
Disease |
Hypertensive renal disease
|
|
Purpose |
To compare the effects of ramipril, amlodipine and metoprolol CR/XL on hypertensive renal disease
|
|
Study design |
Randomised, double-blind, 3 × 2 factorial
|
|
Follow-up |
3-6.4 years
|
|
Patients |
1094 patients (436 ramipril, 217 amlodipine, 441 metoprolol CR/XL), mean age 54 years, with hypertension and glomerular filtration rate (GFR) 20-65 ml/min per 1.73 m2
|
|
Treatment regimen |
Ramipril, 2.5-10 mg/day, or amlodipine, 5-10 mg/day, or metoprolol CR/XL, 50-200 mg/day, (blinded) to a usual mean arterial pressure (MAP) goal of 102-107 mm Hg or to a lower MAP goal of ≤ 92 mm Hg (unblinded)
|
|
Results |
Mean GFR decline did not differ significantly between the lower and usual MAP groups (2.21 vs 1.95 ml/min per 1.73 m2/year; p = 0.24). The mean GFR decline was slower in the ramipril than the metoprolol CR/XL group (1.81 vs 2.42 ml/min per 1.73 m2/year; p = 0.007) and slower in the amlodipine than the metoprolol CR/XL group (1.6 vs 2.68 ml/min per 1.73 m2/year; p = 0.004), but did not differ significantly between the ramipril and amlodipine groups. The risk of the clinical composite outcome (reduction in GFR by ≥ 50% or by ≥ 25 ml/min per 1.73 m2 from the mean of two baseline GFRs, end-stage renal disease or death) did not differ significantly between the lower and usual MAP groups. Compared to the metoprolol CR/XL and amlodipine groups, the ramipril group showed risk reductions in the clinical composite outcome of 22% (p = 0.04) and 38% (p = 0.004), respectively
|
|
Comments |
The results of an interim analysis caused the data and safety monitoring board to terminate the amlodipine arm in September 2000 because of worse outcomes compared to the other two arms. Data on the association between GRK4 polymorphisms and BP response to metoprolol have been published in Am J Hypertens 2009;22:332–8. Data on hyperkalaemia risk in nondiabetic patients have been published in Arch Intern Med 2009;169:1587–94
|
|
|
|
