September 1st, 2010
Long-Term Effect of Intensive BP Control in Blacks
The African-American Study of Kidney Disease and Hypertension (AASK) investigated the role of intensive blood-pressure control in slowing the progression of chronic kidney disease in black patients. In the previously reported results of the randomized portion of AASK, intensive BP control had no effect on the progression of CKD. Now the AASK Collaborative Research Group reports the results of the cohort phase of the study, in which patients who completed the randomized phase were treated with a blood-presssure target of less than 130/80 mm Hg. The findings are presented in the New England Journal of Medicine.
In the cohort phase, the investigators once again found no difference between the groups in the primary trial outcome after a follow-up period of 8.8 to 12.2 years. However, a beneficial effect of intensive control was observed in subjects who had a protein-to-creatinine ratio of more than 0.22 (HR, 0.73; P=0.01).
In an accompanying editorial, Julie Ingelfinger writes that despite the somewhat mixed results in clinical trials, “the concept of intensive control has some data to support it and has been the basis of current guidelines of the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative for a blood-pressure target of under 130/80 mm Hg in patients who have chronic kidney disease without diabetes.” She concludes that AASK “lends hope to the concept that intensive treatment will improve renal outcomes in black patients with hypertension, chronic kidney disease, and microalbuminuria.”