Intensive blood-pressure control in hypertensive chronic kidney disease.

Intensive blood-pressure control in hypertensive chronic kidney disease.

MedLine Citation:	PMID: 20818902 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	BACKGROUND: In observational studies, the relationship between blood pressure and end-stage renal disease (ESRD) is direct and progressive. The burden of hypertension-related chronic kidney disease and ESRD is especially high among black patients. Yet few trials have tested whether intensive blood-pressure control retards the progression of chronic kidney disease among black patients. METHODS: We randomly assigned 1094 black patients with hypertensive chronic kidney disease to receive either intensive or standard blood-pressure control. After completing the trial phase, patients were invited to enroll in a cohort phase in which the blood-pressure target was less than 130/80 mm Hg. The primary clinical outcome in the cohort phase was the progression of chronic kidney disease, which was defined as a doubling of the serum creatinine level, a diagnosis of ESRD, or death. Follow-up ranged from 8.8 to 12.2 years. RESULTS: During the trial phase, the mean blood pressure was 130/78 mm Hg in the intensive-control group and 141/86 mm Hg in the standard-control group. During the cohort phase, corresponding mean blood pressures were 131/78 mm Hg and 134/78 mm Hg. In both phases, there was no significant between-group difference in the risk of the primary outcome (hazard ratio in the intensive-control group, 0.91; P=0.27). However, the effects differed according to the baseline level of proteinuria (P=0.02 for interaction), with a potential benefit in patients with a protein-to-creatinine ratio of more than 0.22 (hazard ratio, 0.73; P=0.01). CONCLUSIONS: In overall analyses, intensive blood-pressure control had no effect on kidney disease progression. However, there may be differential effects of intensive blood-pressure control in patients with and those without baseline proteinuria. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center on Minority Health and Health Disparities, and others.)

Authors:	Lawrence J Appel; Jackson T Wright; Tom Greene; Lawrence Y Agodoa; Brad C Astor; George L Bakris; William H Cleveland; Jeanne Charleston; Gabriel Contreras; Marquetta L Faulkner; Francis B Gabbai; Jennifer J Gassman; Lee A Hebert; Kenneth A Jamerson; Joel D Kopple; John W Kusek; James P Lash; Janice P Lea; Julia B Lewis; Michael S Lipkowitz; Shaul G Massry; Edgar R Miller; Keith Norris; Robert A Phillips; Velvie A Pogue; Otelio S Randall; Stephen G Rostand; Miroslaw J Smogorzewski; Robert D Toto; Xuelei Wang;
Publication Detail:	Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
Journal Detail:	Title: The New England journal of medicine Volume: 363 ISSN: 1533-4406 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2010 Sep
Date Detail:	Created Date: 2010-09-07 Completed Date: 2010-09-16 Revised Date: 2013-01-31
Medline Journal Info:	Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: United States
Other Details:	Languages: eng Pagination: 918-29 Citation Subset: AIM; IM
Affiliation:	Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2223, USA. lappel@jhmi.edu
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MeSH Terms
Descriptor/Qualifier:	Adult African Americans* Aged Albuminuria Angiotensin II Type 1 Receptor Blockers / therapeutic use Angiotensin-Converting Enzyme Inhibitors / therapeutic use Antihypertensive Agents / therapeutic use* Blood Pressure Cohort Studies Creatinine / blood Disease Progression Female Humans Hypertension / complications, drug therapy, ethnology Kidney Failure, Chronic / prevention & control Male Middle Aged Renal Insufficiency, Chronic / drug therapy, ethnology*, etiology
Grant Support
ID/Acronym/Agency:	2P20 RR11104/RR/NCRR NIH HHS; DK 2818-02/DK/NIDDK NIH HHS; K24 DK002818-02/DK/NIDDK NIH HHS; K24 DK002818-10/DK/NIDDK NIH HHS; M01 RR-00071/RR/NCRR NIH HHS; M01 RR-00080/RR/NCRR NIH HHS; M01 RR00052/RR/NCRR NIH HHS; M01 RR00827/RR/NCRR NIH HHS; M0100032//PHS HHS; P20 RR011145-14/RR/NCRR NIH HHS; P20-RR11145/RR/NCRR NIH HHS; RR029887/RR/NCRR NIH HHS; U01 DK045386-15S1/DK/NIDDK NIH HHS; UL1 RR029887/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:	0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 60-27-5/Creatinine
Investigator
Investigator/Affiliation:	J T Wright / ; M Rahman / ; R Dancie / ; L Strauss / ; J Lea / ; B Wilkening / ; A Chapman / ; D Watkins / ; J D Kopple / ; L Miladinovich / ; J Choi / ; P Oleskie / ; C Secules / ; V Pogue / ; D Dowie / ; H Anderson / ; L Herbert / ; R Locko / ; H Nurse / ; J-T Cheng / ; F Darkwa / ; V Dowdy / ; B Nicholas / ; O Randall / ; T Retta / ; S Xu / ; M Ketete / ; D Ordor / ; C Tilghman / ; E Miller / ; B Astor / ; C Diggs / ; J Charleston / ; C Harris / ; T Shields / ; Lawrence Appel / ; K Norris / ; D Martins / ; M Miller / ; H Howell / ; L Pitts / ; D Cheek / ; D Brooks / ; M Faulkner / ; O Adeyele / ; K Phillips / ; G Sanford / ; C Weaver / ; W Cleveland / ; K Chapman / ; W Smith / ; S Glover / ; R Phillips / ; M Lipkowitz / ; M Rafey / ; A Gabriel / ; E Condren / ; N Coke / ; L Hebert / ; G Shidham / ; L Hiremath / ; S Justice / ; G Bakris / ; J Lash / ; L Fondren / ; L Bagnuolo / ; J Cohan / ; A Frydrych / ; S Rostand / ; D Thornley-Brown / ; B Key / ; F B Gabbai / ; D T O'Connor / ; B Thomas / ; C C Tisher / ; G Bichier / ; C Sarmiento / ; A Diaz / ; C Gordon / ; G Contreras / ; J Bourgoignie / ; D Florence-Green / ; J Junco / ; J Vassallo / ; K Jamerson / ; A Ojo / ; T Corbin / ; D Cornish-Zirker / ; T Graham / ; W Bloembergen / ; S Massry / ; M Smogorzewski / ; A Richardson / ; L Pitts / ; R Toto / ; G Peterson / ; R Saxena / ; T Lightfoot / ; S-A Blackstone / ; C Loreto / ; J Lewis / ; G Schulman / ; M Sika / ; S McLeroy / ; L Y Agodoa / ; J P Briggs / ; J W Kusek / ; J Gassman / ; G Beck / ; T Greene / ; B Hu / ; K Brittain / ; S Sherer / ; L Tuason / ; C Kendrick / ; S Bi / ; H Litowitz / ; X Liu / ; X Wang / ; K Wiggins / ; C A Tatum / ; N Patterson / ; F Van Lente / ; J Waletzky / ; C O'Laughlin / ; L Burton / ; W McClellan / ; L Adams-Campbell / ; K Faber-Langendoen / ; B Kiberd / ; E Lee / ; T Meyer / ; D Nathan / ; J Stokes / ; H Taylor / ; P W Wilson / ; T deBacker / ; A Lansky / ; S Slack /
Comments/Corrections
Comment In:	N Engl J Med. 2010 Dec 23;363(26):2564-5; author reply 2565-6 [PMID: 21175325 ] J Clin Hypertens (Greenwich). 2011 Mar;13(3):214-6 [PMID: 21366854 ] Curr Hypertens Rep. 2011 Apr;13(2):93-5 [PMID: 21210307 ] N Engl J Med. 2010 Dec 23;363(26):2565; author reply 2565-6 [PMID: 21175324 ] N Engl J Med. 2010 Dec 23;363(26):2564; author reply 2565-6 [PMID: 21175326 ] N Engl J Med. 2010 Sep 2;363(10):974-6 [PMID: 20818909 ]

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