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Successful Blood Pressure Control in the African American Study of Kidney Disease and Hypertension
Jackson T. Wright, Jr, MD,PhD;
Lawrence Agodoa, MD;
Gabriel Contreras, MD;
Tom Greene, PhD;
Janice G. Douglas, MD;
James Lash, MD;
Otelio Randall, MD;
Nancy Rogers, MS,CCRC;
Michael C. Smith, MD;
Shaul Massry, MD;
for the African American Study of Kidney Disease and Hypertension Study Group
Arch Intern Med. 2002;162:1636-1643.
Background The African American Study of Kidney Disease and Hypertension (AASK) is an ongoing trial to evaluate the effect of blood pressure and choice of antihypertensive drug on the rate of decline of renal function.
Objective To present the success of the AASK in achieving the trial's rigorous blood pressure goals in an extremely challenging patient population.
Methods The AASK participants included African American patients with hypertension (n = 1094), aged 18 to 70 years, with glomerular filtration rates between 20 and 65 mL/min per 1.73 m2 and no other identified causes of renal insufficiency. Participants were randomized to a goal mean arterial blood pressure (MAP) of either 102 to 107 mm Hg (usual MAP goal) or 92 mm Hg or less (low MAP goal). Participants in each of these groups were also randomized (double-blind) to a regimen containing metoprolol succinate, ramipril, or amlodipine besylate. Additional agents were added, if required, in the following recommended order: furosemide, doxazosin mesylate, clonidine hydrochloride, or hydralazine hydrochloride (or minoxidil, if needed).
Results In participants randomized to the low MAP goal, the percentage of participants who achieved a blood pressure of less than 140/90 mm Hg increased from a baseline of 20.0% to 78.9% by 14 months after randomization. For usual MAP goal participants, the corresponding percentages increased from 21.5% to 41.8%. The difference in median levels of MAP between the 2 MAP goal groups increased and remained at approximately 12 mm Hg. Blood pressure reduction was similar regardless of age, sex, body mass index, education, insurance or employment status, income, or marital status.
Conclusion The blood pressure goals set and achieved in AASK participants clearly demonstrate that adequate blood pressure control can be achieved even in hypertensive populations whose blood pressure is the most difficult to control.
From the Department of Medicine, Divisions of Hypertension (Drs Wright and Douglas) and Nephrology (Dr Smith), Case Western Reserve University, Cleveland, Ohio; Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md (Dr Agodoa); Department of Medicine, Division of Nephrology, University of Miami, Miami, Fla (Dr Contreras); Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio (Dr Greene); Department of Medicine, Division of Nephrology, University of Illinois, Chicago (Dr Lash); Department of Medicine, Division of Cardiology, Howard University, Washington, DC (Dr Randall); Department of Medicine, Division of Hypertension, Emory University, Atlanta, Ga (Ms Rogers); and Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles (Dr Massry).
Nancy Rogers, MS, CCRD is deceased.
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