Blood pressure control, drug therapy, and kidney disease

Area of Science:

• Nephrology
• Hypertension Research
• Clinical Trials

Background:

• The African American Study of Kidney Disease and Hypertension (AASK) investigated blood pressure (BP) management strategies.
• Previous AASK findings showed similar BP intervention effects across all drug groups for primary renal outcomes.

Purpose of the Study:

• To analyze the impact of BP intervention separately within different antihypertensive drug groups.
• To identify potential differential effects of BP goals on kidney disease progression based on medication.

Main Methods:

• The study involved 2 blood pressure (BP) goals: low mean arterial pressure (MAP) < or =92 mm Hg and usual MAP 102 to 107 mm Hg.
• Three antihypertensive drugs were used: ramipril, amlodipine, and metoprolol.
• Secondary analyses examined BP intervention effects within each drug group for specific renal outcomes.

Main Results:

• While BP intervention effects were similar for GFR slope and a composite of ESRD/death/GFR decline across drug groups, significant differences emerged for ESRD or death (P=0.035) and ESRD alone (P=0.021).
• Amlodipine patients at the usual BP goal had higher event rates for ESRD or death and ESRD compared to other groups.
• The low BP goal significantly reduced the risk of ESRD or death (51% risk reduction) and ESRD (54% risk reduction) specifically in amlodipine patients.

Conclusions:

• The low blood pressure goal demonstrated a potential benefit in reducing the risk of end-stage renal disease (ESRD) or death among patients treated with amlodipine.
• These findings highlight a possible interaction between BP targets and antihypertensive medications in managing kidney disease progression.
• Further cautious interpretation is warranted for these secondary analyses regarding amlodipine and low BP goals.