Author Affiliation: Department of Cardiology, Veterans Affairs Medical Center, Washington, DC.
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.
Papademetriou V. Selection of Antihypertensive Therapy for Patients With Hypertensive Renal Disease. JAMA. 2001;285(21):2774–2776. doi:10.1001/jama.285.21.2774
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