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Denyse Thornley-Brown, MD; Xuelei Wang, MS; Jackson T. Wright, Jr, MD, PhD; Otelio S. Randall, MD; Edgar R. Miller, MD, PhD; James P. Lash, MD; Jennifer Gassman, PhD; Gabriel Contreras, MD, MPH; Lawrence J. Appel, MD, MPH; Lawrence Y. Agodoa, MD; DeAnna Cheek, MD; for the African American Study of Kidney Disease and Hypertension Study Group

Arch Intern Med. 2006;166:797-805.

Background  The African American Study of Kidney Disease and Hypertension was a multicenter trial of African Americans with hypertensive kidney disease randomized to an angiotensin-converting enzyme inhibitor (ramipril), a -blocker (metoprolol succinate), or a calcium channel blocker (amlodipine besylate). We compared the incidence of type 2 diabetes mellitus (DM) and the composite outcome of impaired fasting glucose or DM (IFG/DM) for the African American Study of Kidney Disease and Hypertension interventions.

Methods  Cox regression models were used to evaluate (post hoc) the association of the randomized interventions and the relative risk (RR) of DM and IFG/DM and to assess the RR of DM and IFG/DM by several prerandomization characteristics.

Results  Among 1017 participants, 147 (14.5%) developed DM; 333 (42.9%) of 776 participants developed IFG/DM. Respective DM event rates were 2.8%, 4.4%, and 4.5% per patient-year in the ramipril-, amlodipine-, and metoprolol-treated groups. The RRs of DM with ramipril treatment were 0.53 (P = .001) compared with metoprolol treatment and 0.49 (P = .003) compared with amlodipine treatment. Respective IFG/DM event rates were 11.3%, 13.3%, and 15.8% per patient-year in the ramipril-, amlodipine-, and metoprolol-treated groups. The RRs of IFG/DM with ramipril treatment were 0.64 (P<.001) compared with metoprolol treatment and 0.76 (P = .09) compared with amlodipine treatment. The RRs of DM and IFG/DM with amlodipine treatment compared with metoprolol treatment were 1.07 (P = .76) and 0.84 (P = .26), respectively.

Conclusion  Ramipril treatment was associated with a significantly lower risk of DM in African Americans with hypertensive kidney disease than amlodipine or metoprolol treatment.

Author Affiliations: Division of Nephrology, University of Alabama at Birmingham (Dr Thornley-Brown); Department of Quantitative Health Sciences, Cleveland Clinic Foundation (Ms Wang and Dr Gassman) and University Hospitals of Cleveland and the Louis Stokes Cleveland Veterans Administration Medical Center, Case Western Reserve University, Cleveland, Ohio (Dr Wright); Howard University Hospital, Howard University, Washington, DC (Dr Randall); Department of Medicine and Epidemiology (Dr Miller) and the Welch Center (Dr Appel), The Johns Hopkins University, and National Institute on Aging, Baltimore, Md (Dr Miller); Section of Nephrology, University of Illinois at Chicago (Dr Lash); Division of Nephrology, University of Miami, Miami, Fla (Dr Contreras); Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md (Dr Agodoa); and Division of Pediatric Nephrology, Medical University of South Carolina, Charleston (Dr Cheek).
Group Information: A listing of the African American Study of Kidney Disease and Hypertension Study Group participating centers and investigators was published in JAMA (2002;288:2421).

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