ACE Inhibitor Offers Best Kidney Protection for African-Americans


By: Jan Chait

A recent study comparing three classes of blood pressure medications found that an ACE inhibitor did the best job of slowing kidney disease in African-Americans.

The study was the largest clinical trial ever conducted among African-Americans with kidney disease, involving 1,094 adult subjects at 21 centers for up to 6.4 years.

Participants in the African American Study of Kidney Disease and Hypertension (AASK) took either the ACE inhibitor Altace (ramipril), the dihydropyridine calcium channel blocker Norvasc (amlodipine) or the beta blocker Toprol XL (metoprolol).

Altace reduced the risk of reaching the clinical end-points of kidney failure by 22 percent compared to Toprol and by 38 percent compared to Norvasc.

Although the study ended in September 2001, the use of Norvasc in this study was halted a year earlier after results showed that the ACE inhibitor slowed kidney disease by 36 percent and reduced the risk of kidney failure and death by 48 percent in subjects who had at least 1 gram of protein in the urine.

“We were surprised that a very low blood pressure level didn’t have more of an effect on the kidney,” said co-author Dr. Lawrence Agodoa, who specializes in kidney diseases at the National Institutes of Health. Researchers compared a blood pressure goal of 140/90 in 554 subjects against a lower goal of 125/75 in 540 subjects.

Journal of the American Medical Association, November 20, 2002



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