Intensive blood-pressure control in hypertensive chronic kidney disease
| Autor: | 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, S, Slack |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Departments Hemodynamics Angiotensin-Converting Enzyme Inhibitors Blood Pressure law.invention Cohort Studies Randomized controlled trial law Internal medicine medicine Albuminuria Humans Renal Insufficiency Chronic Antihypertensive Agents Aged business.industry General Medicine Middle Aged medicine.disease Surgery Black or African American Blood pressure Mean blood pressure Creatinine Cohort Hypertension Disease Progression Kidney Failure Chronic Female medicine.symptom business Angiotensin II Type 1 Receptor Blockers Cohort study Kidney disease |
| Zdroj: | J Clin Hypertens (Greenwich) |
| ISSN: | 1533-4406 |
| Popis: | 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.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.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).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.) |
| Databáze: | OpenAIRE |
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