Successful Blood Pressure Control in the African American Study of Kidney Disease and Hypertension

Wright, Jackson T.

doi:10.1001/archinte.162.14.1636

Cited by 123 publications

(78 citation statements)

References 19 publications

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“…First, although African Americans with CKD represent an important population for study, our findings cannot necessarily be extrapolated to nonblack patients with CKD or those whose renal disease is caused by other etiologies. Second, BP control in the AASK study was superior to that observed in many other trials and likely the general population (36). Although this also may somewhat detract from the generalizability of our findings, the attention paid to participants in AASK increases the internal validity of our findings by limiting the effect of external factors on SBV.…”

Section: Discussionmentioning

confidence: 56%

Association of BP Variability with Mortality among African Americans with CKD

McMullan

Bakris

Phillips

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Increased systolic BP visit-to-visit variability (SBV) may be associated with higher overall mortality and cardiovascular events. However, few studies have examined these associations in patients with CKD, and the relation of SBV with CKD progression and ESRD has not been shown. This study analyzed the association of SBV with overall mortality, cardiovascular mortality, cardiovascular events, and renal events among individuals enrolled in the African American Study of Kidney Disease (AASK) trial.Design, setting, participants, & measurements This was a prospective observational study of 908 participants during the trial phase of the AASK study, with at least 1 year of BP measurements available and followed for 3-6.4 years. SBV was calculated as the SD of the systolic pressure from five visits occurring 3-12 months after randomization. The association of SBV with risk of overall mortality, cardiovascular mortality, a composite of fatal and nonfatal cardiovascular events, and a composite of renal events was assessed using proportional hazards regression and adjusting for multiple potential confounders.Results Greater SBV was associated with higher overall mortality. The adjusted hazard ratio (95% confidence interval) was 2.82 (1.14-6.95) comparing the highest with lowest tertile of SBV. A similar comparison revealed that greater SBV was also associated with cardiovascular mortality (adjusted hazard ratio, 4.91; 1.12-21.50). SBV was associated with both the cardiovascular renal composite endpoints in unadjusted but not adjusted analyses.Conclusions In African Americans with CKD, SBV is strongly and independently associated with overall and cardiovascular mortality.

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Section: Discussionmentioning

confidence: 56%

Association of BP Variability with Mortality among African Americans with CKD

McMullan

Bakris

Phillips

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…The protocol and procedures were approved by the institutional review board at each center, and all participants gave written informed consent (10,11).…”

Section: Methodsmentioning

confidence: 99%

“…We use data from the recently completed AASK to evaluate whether use of serum creatinine measurements (or estimated GFR from equations based on serum creatinine measurements) would alter any of the primary conclusions of the study compared with the conclusions reached on the basis of direct measurements of 125 I-iothalamate GFR (iGFR) (10,11). The comparison of iGFR with serum creatinine-based results was performed for three types of analysis.…”

mentioning

confidence: 99%

A Comparison of Iothalamate-GFR and Serum Creatinine-Based Outcomes

Lewis¹,

Greene²,

Appel³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. In renal clinical trials, both slope-based and timeto-event renal outcomes have been used. These outcomes are typically based on estimates of GFR obtained using creatinine or iothalamate GFR (iGFR). The African American Study of Kidney Disease and Hypertension (AASK) was a trial in 1094 African Americans with hypertensive nephrosclerosis, which examined the effects of two levels of BP control and three antihypertensive regimens. This study compared the effects of the AASK interventions on outcomes based on serum creatinine with corresponding outcomes based on iGFR using 9742 matched pairs of iGFR and serum creatinine measurements. The iGFR-based outcomes included (1) a time-to-event composite outcome including a 50% GFR decline, ESRD, or death; (2) a composite outcome including a 50% GFR decline or ESRD; (3) mean decline in GFR in the first 3 mo after randomization (acute slope); (4) mean decline in GFR starting 3 mo after randomization (chronic slope); and (5) mean decline in GFR from baseline (total slope). The corresponding creatininebased outcomes were (1) a composite of doubling of serum creatinine, ESRD, or death and (2) a composite of doubling of serum creatinine or ESRD and acute, chronic, and total slopes defined by the mean change in estimated GFR (eGFR), where eGFR was estimated from a regression equation for GFR depending primarily on serum creatinine and developed in AASK enrollees. Mean changes in iGFR and eGFR were also compared under extended models that allowed for the possibility that the rate of GFR decline may change over time during the chronic phase. an apparent acceleration in rate of decline of renal function over time was found. Subtle differences were observed between effects of the interventions on some of the creatinine and iGFR slope-based outcomes, but the main conclusions of the trial were similar for the serum creatinine and iothalamatebased measurements. This has important implications for the design of clinical trials with renal outcomes.Choosing appropriate outcomes is critical to the success of clinical trials. In renal clinical trials to date, both slope-based and time-to-event renal outcomes have been used (1-5). In the slope-based analysis, GFR is estimated at multiple time points for all participants and curves constructed from these points that reflect the change in renal function over time. In most cases, constant slopes over time are assumed, and mean slopes are compared between the study groups to evaluate the effects of interventions on the rate of GFR decline. In time-to-event analysis, an event such as halving of GFR or ESRD is measured, and the time from randomization to the occurrence of these events is compared between the study groups.Inulin clearance is arguably the gold standard for accurately measuring GFR (6). In large clinical trials, however, 125

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“…11 However, patients with high values of MAP, proteinuria or SCr were excluded from the MDRD study, which may explain the difference. In the recently published African American Study of Kidney Disease and Hypertension (AASK) 12 the degree of BP goal achievement was considerably higher than in the Blood pressure control in chronic renal failure T Giverhaug et al present study. However, the included patients were younger, healthier and probably more adherent to their drug therapy than ours, as only self-identified patients with impaired renal function due to essential hypertension were included.…”

Section: Bp and Goal Achievementmentioning

confidence: 53%

“…12 However, a comparison of the number of drugs required is of limited value without ensuring that optimal dose titration has been performed and that comorbidity has been taken into account. In the AASK study, 12 the dosage of each AHT was titrated to the maximum tolerated dose before adding a new agent. In the present study, some of the patients suffered from heart diseases and were probably prescribed drugs here defined as AHT for indications other than hypertension.…”

Section: Antihypertensive Medication and Prescription Patternsmentioning

confidence: 99%

Effectiveness of antihypertensive treatment in chronic renal failure: to what extent and with which drugs do patients treated by nephrologists achieve the recommended blood pressure?

2004

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Adequate control of blood pressure (BP) is important to slow the progression of chronic renal failure (CRF). The Joint National Committee (JNC) VI recommends BP o130/85 mmHg, or o125/75 mmHg if urinary protein excretion exceeds 1 g/d. Angiotensin converting enzyme inhibitors (ACE-I) are considered as first-line agents. The current study is a survey of the degree of goal achievement and prescription patterns of antihypertensive (AHT) medication according to the JNC guidelines in clinical nephrology practice. All patients with CRF, not on renal replacement therapy, treated by nephrologists at the University Hospital of North-Norway were included in this retrospective cross-sectional study. Data on protein:creatinine ratio (PC ratio), BP and AHT drugs prescribed were extracted from the hospital's databases and medical records. A total of 144 patients were included. The patients' age was 62716 years and the serum creatinine value was 210792 lmol/l (mean7s.d.). In all, 74 patients (51%) had PC ratio p1, 36 (25%) 41, and for 34 (24%) PC ratio had not been measured; 23 (31%) of the patients with PC ratio p1 had BP p130/85 (139721/78712), and 5 (14%) of those with PC ratio 41 had BP p125/75 (145722/85714). Failure to achieve the goal was most commonly due to elevated SBP. In all, 55 % of the patients were prescribed ACE-I or angiotensin receptor blocker (ARB). In conclusion, the recommended BP goals may be difficult to achieve for a high proportion of patients in clinical practice due to difficulty in lowering SBP. There is a potential for improved treatment of hypertension in CRF patients, including increased prescription of ACE-I and ARB.

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Successful Blood Pressure Control in the African American Study of Kidney Disease and Hypertension

Abstract: 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.

Cited by 123 publications

References 19 publications

Association of BP Variability with Mortality among African Americans with CKD

Association of BP Variability with Mortality among African Americans with CKD

A Comparison of Iothalamate-GFR and Serum Creatinine-Based Outcomes

Effectiveness of antihypertensive treatment in chronic renal failure: to what extent and with which drugs do patients treated by nephrologists achieve the recommended blood pressure?

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