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June 6, 2001

Selection of Antihypertensive Therapy for Patients With Hypertensive Renal Disease

Author Affiliations

Author Affiliation: Department of Cardiology, Veterans Affairs Medical Center, Washington, DC.

JAMA. 2001;285(21):2774-2776. doi:10.1001/jama.285.21.2774

Hypertension is a major contributor to cardiovascular morbidity and mortality in industrialized countries. During the last 3 decades, multiple prospective randomized trials, reported individually or in meta-analyses,1 demonstrated a dramatic reduction of vascular events attributable to hypertension. At the same time, however, the incidence of end-stage renal disease (ESRD) and congestive heart failure (CHF) has steadily increased.2,3 African Americans are particularly affected by these trends, since they have a higher prevalence and exhibit more severe forms of hypertension, resulting in higher rates of vascular complications. In particular, ESRD attributable to hypertension has increased at a rate that is several-fold higher among African American patients than white patients.4 Although tight blood pressure control is known to be a crucial factor in preventing progression of renal disease, other factors are undoubtedly involved. The potential renal protective effect of specific pharmacologic therapy has been addressed in only a few studies. Recently published reports indicate benefits from angiotensin-converting enzyme inhibitor (ACEI) therapy in patients with diabetes and in those with proteinuria without diabetes,5,6 but these studies included mostly white patients.