Effect of Ramipril vs Amlodipine on Renal Outcomes in Hypertensive NephrosclerosisA Randomized Controlled Trial

Abstract

The mortality from hypertensive vascular disease has declined progressively over the past 2 decades in the United States, a decline ascribed in part to improved treatment of high blood pressure (BP). During the same period, the incidence of end-stage renal disease (ESRD) due to hypertension has increased steadily, particularly among African Americans.¹ In certain age groups, the risk of hypertensive ESRD for African Americans is 20-fold greater than in whites.^1,2 The optimal strategy for treatment of hypertension to prevent renal failure has remained elusive. Recent data in participants with diabetic and proteinuric nondiabetic kidney disease have suggested significant benefits with angiotensin-converting enzyme inhibitors (ACEIs).^3-7 The impact of ACEIs on progression of renal disease in African Americans is unknown since all published trials had too few African Americans randomized to such agents.^8,9 Although animal studies have demonstrated prevention of glomerulosclerosis by calcium channel blockers (CCBs),^10-12 human studies have not consistently confirmed their renoprotective effects.^5,12-16