Cardiovascular Outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial

• DOI: 10.1053/j.ajkd.2006.08.004
• Publication Date: 2007-02-06T16:05:03Z
• Authors: Keith Norris; Jacque Bourgoigne; Jennifer Gassman; Lee Hebert; John Middleton; Robert A. Phillips; Otelio Randall; Stephen Rostand; Susan Sherer; Robert D. Toto; Jackson T. Wright; Xuelei Wang; Tom Greene; Lawrence J. Appel; Julia Lewis
• Keywords: Adult; Hypertension, Renal; Nephrosclerosis; Adolescent; Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Middle Aged; Calcium Channel Blockers; Prognosis; Risk Assessment; 3. Good health; Black or African American; 03 medical and health sciences; 0302 clinical medicine; Cardiovascular Diseases; Risk Factors; Creatinine; Hypertension; Multivariate Analysis; Humans; Antihypertensive Agents; Aged; Proportional Hazards Models

Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events.We randomly assigned 1,094 African Americans with hypertensive nephrosclerosis (glomerular filtration rate [GFR], 20 to 65 mL/min/1.73 m(2) [0.33 to 1.08 mL/s]) to initial antihypertensive treatment with either: (1) a beta-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.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 dollars.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.