ACE Inhibitors and Hypertensive Renal Disease in Blacks

Risk for hypertensive renal disease is higher in blacks than in whites. Angiotensin-converting-enzyme (ACE) inhibitors slow the progression of renal disease, but data have suggested that blacks are less responsive to the effects of ACE inhibitors than are whites. This randomized, multicenter, U.S. trial was designed to compare outcomes with 3 antihypertensive drugs -- metoprolol, amlodipine, and ramipril -- in 653 self-designated African Americans with hypertension and renal insufficiency (glomerular filtration rate [GFR], 20-65 mL/min per 1.73 m²/y). The study was funded partially by the drug manufacturers.

At 3 years, the amlodipine study arm was terminated because of higher rates of end-stage renal disease and death; data collected from t…