The Pharmaceutical Journal
Vol 269 No 7226 p771
30 November 2002

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JAMA: abstract (more)

Further reductions in blood pressure do not slow progression of hypertensive nephrosclerosis

Additional reduction in blood pressure does not slow the progression of hypertensive nephrosclerosis, researchers report. However, they support recommendations that angiotensin-converting enzyme inhibitors should be considered as first-line therapy over beta-blockers and dihydropyridine calcium channel blockers in these patients.

Dr Jackson Wright, University Hospitals of Cleveland, and colleagues from the African American study of kidney disease and hypertension (AASK) study group compared the effects of three classes of antihypertensives and two levels of blood pressure control on the decline in kidney function in black patients with chronic kidney disease attributed to hypertensive nephrosclerosis.

They randomly assigned 1,094 patients aged 18 to 70 years, to receive treatment with metoprolol, ramipril (Tritace) or amlodipine (Istin), and to achieve a target mean arterial pressure of either 102–107mmHg (usual) or 92mmHg or less (lower).

The researchers found that mean glomerular filtration rate (GFR) decline from baseline through four years did not differ between the two blood pressure groups. In addition, the lower blood pressure goal did not reduce the rate of GFR decline, end-stage renal failure [dialysis or transplantation] or death when the outcomes were combined.

They say that none of the drug group comparisons showed consistent differences in GFR decline. However, ramipril was more effective than metoprolol and amlodipine in reducing the risk of the combined clinical outcome.

The study is published in JAMA (2002;288:2421).