Does Intensive Blood Pressure Control Delay Progression of Hypertension-Related Kidney Disease?

In the previously published African-American Study of Kidney Disease and Hypertension (AASK), 1094 nondiabetic black patients with hypertension-related chronic kidney disease were randomized to intensive or standard blood pressure (BP) control. Despite significantly lower average BP with intensive treatment (130/78 mm Hg vs. 141/86 mm Hg), a composite outcome (50% reduction in glomerular filtration rate, end-stage renal disease, or death) was similar in the two groups at 4 years (JW Gen Med Dec 17 2002). In the AASK trial, researchers also compared ramipril, metoprolol, and amlodipine as initial therapies; outcomes were best with ramipril.

After the randomized phase, patients were followed for about 6 more years in a “cohort phase,” during w…