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

Am J Kidney Dis. 2006 Nov;48(5):739-51. doi: 10.1053/j.ajkd.2006.08.004.

Abstract

Background: Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events.

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • African Americans*
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use*
  • Calcium Channel Blockers / therapeutic use
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology
  • Creatinine / blood
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy
  • Hypertension / ethnology
  • Hypertension, Renal / complications
  • Hypertension, Renal / drug therapy*
  • Hypertension, Renal / ethnology
  • Middle Aged
  • Multivariate Analysis
  • Nephrosclerosis / complications*
  • Nephrosclerosis / drug therapy*
  • Nephrosclerosis / ethnology
  • Nephrosclerosis / etiology
  • Prognosis
  • Proportional Hazards Models
  • Risk Assessment
  • Risk Factors

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Creatinine