TY - JOUR
T1 - Cardiovascular Outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial
AU - Norris, Keith
AU - Bourgoigne, Jacque
AU - Gassman, Jennifer
AU - Hebert, Lee
AU - Middleton, John
AU - Phillips, Robert A.
AU - Randall, Otelio
AU - Rostand, Stephen
AU - Sherer, Susan
AU - Toto, Robert D.
AU - Wright, Jackson T.
AU - Wang, Xuelei
AU - Greene, Tom
AU - Appel, Lawrence J.
AU - Lewis, Julia
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2006/11
Y1 - 2006/11
N2 - Background: Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events. Methods: We randomly assigned 1,094 African Americans with hypertensive nephrosclerosis (glomerular filtration rate [GFR], 20 to 65 mL/min/1.73 m2 [0.33 to 1.08 mL/s]) to initial antihypertensive treatment with either: (1) a β-blocker, metoprolol; (2) an angiotensin-converting enzyme inhibitor, ramipril; or (3) a dihydropyridine calcium channel blocker, amlodipine, and either a usual-blood pressure (BP) or low-BP treatment goal. Using a design powered to detect renal outcome differences, we compared the effect of treatment on the CV event rate (cardiac death, myocardial infarction, stroke, and heart failure) during a mean follow-up period of 4.1 years and determined baseline factors that predict CV outcomes. Results: Thirty-one patients died of CV disease (0.7%/patient-year), and 149 patients experienced at least 1 CV outcome (3.3%/patient-year). Overall, 202 CV events (4.5%/patient-year) occurred. The CV outcome rate was not related significantly to randomized interventions. In multivariable analyses, 7 baseline risk factors remained independently associated with increased risk for the CV composite outcome after controlling for age, sex, baseline GFR, and baseline proteinuria group: pulse pressure, duration of hypertension, abnormal electrocardiogram result, non-high-density lipoprotein cholesterol level, serum urea nitrogen level, urine protein-creatinine ratio, urine sodium-potassium ratio, and annual income less than $15,000. Conclusion: Neither randomized class of antihypertensive therapy nor BP level had a significant effect on the occurrence of CV events, possibly because of limited power. However, this analysis identifies unique and potentially modifiable CV risk factors in this high-risk cohort.
AB - Background: Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events. Methods: We randomly assigned 1,094 African Americans with hypertensive nephrosclerosis (glomerular filtration rate [GFR], 20 to 65 mL/min/1.73 m2 [0.33 to 1.08 mL/s]) to initial antihypertensive treatment with either: (1) a β-blocker, metoprolol; (2) an angiotensin-converting enzyme inhibitor, ramipril; or (3) a dihydropyridine calcium channel blocker, amlodipine, and either a usual-blood pressure (BP) or low-BP treatment goal. Using a design powered to detect renal outcome differences, we compared the effect of treatment on the CV event rate (cardiac death, myocardial infarction, stroke, and heart failure) during a mean follow-up period of 4.1 years and determined baseline factors that predict CV outcomes. Results: Thirty-one patients died of CV disease (0.7%/patient-year), and 149 patients experienced at least 1 CV outcome (3.3%/patient-year). Overall, 202 CV events (4.5%/patient-year) occurred. The CV outcome rate was not related significantly to randomized interventions. In multivariable analyses, 7 baseline risk factors remained independently associated with increased risk for the CV composite outcome after controlling for age, sex, baseline GFR, and baseline proteinuria group: pulse pressure, duration of hypertension, abnormal electrocardiogram result, non-high-density lipoprotein cholesterol level, serum urea nitrogen level, urine protein-creatinine ratio, urine sodium-potassium ratio, and annual income less than $15,000. Conclusion: Neither randomized class of antihypertensive therapy nor BP level had a significant effect on the occurrence of CV events, possibly because of limited power. However, this analysis identifies unique and potentially modifiable CV risk factors in this high-risk cohort.
KW - Inhibitor
KW - calcium channel blocker
KW - cardiovascular
KW - chronic kidney disease
KW - hypertension
KW - β-blocker
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U2 - 10.1053/j.ajkd.2006.08.004
DO - 10.1053/j.ajkd.2006.08.004
M3 - Article
C2 - 17059993
AN - SCOPUS:33751014040
VL - 48
SP - 739
EP - 751
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 5
ER -