Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Wright and colleagues of
the AASK trial1 found that among patients
with hypertensive kidney disease, the rate of decline in glomerular filtration
rate (GFR) was unaffected by either degree of blood pressure (BP) control
or by class of antihypertensive agent. However, they did find that patients
who received ramipril had a lower risk of a clinical composite outcome than
did those who received either amlodipine or metoprolol. A previous report
of the AASK trial2 found that ramipril improved
renal survival compared with amlodipine at 3-year follow-up, and thus the
amlodipine arm was terminated for an ethical reason. We are disappointed that
the authors did not report any comparisons between participants receiving
amlodipine but with different degrees of BP control.
Michio Fukuda, Takeshi Usami, Atsuhiro Yoshida, Genjiro Kimura. Antihypertensive Drugs and Renal Protection. JAMA. 2003;289(9):1102–1103. doi:10.1001/jama.289.9.1102-a