Research Updates in Kidney and Urologic Health

ACE Inhibitor Reduces the Risk of Kidney Failure in Hypertension

People with kidney disease from high blood pressure have a better chance of reducing the risk of kidney failure if they take an angiotensin-converting enzyme (ACE) inhibitor, according to a National Institutes of Health study in the Journal of the American Medical Association published on June 6, 2001.

The African American Study of Kidney Disease and Hypertension (AASK) found that the ACE inhibitor ramipril slowed kidney disease by 36 percent and slashed the risk of kidney failure and death by 48 percent in patients who had at least a gram of protein in their urine. The drug was compared with the dihydropyridine calcium channel blocker (CCB) amlodipine. Results were not related to blood pressure control, which was comparable between study groups.

ACE inhibitors have been the preferred treatment for kidney disease of diabetes since 1994, and now AASK doctors are recommending it for kidney disease of hypertension, especially for people who also have protein in their urine. While CCBs help many patients, particularly African Americans, control blood pressure and reduce the risk of stroke and heart disease, patients may need an ACE inhibitor to protect the kidneys.

On the advice of a data and safety monitoring board, AASK investigators stopped using the CCB as a main-line treatment in September 2000. They will continue to compare the ACE inhibitor and the beta blocker metoprolol and two blood pressure goals until the fall of 2001, when the study will end.

African Americans make up 13.9 percent of the U.S. population but 29.8 percent of those treated for kidney failure. Hardest hit are blacks ages 25 to 44, who are 20 times more vulnerable to hypertensive kidney failure. Although better management of high blood pressure has led to fewer strokes and heart disease, kidney failure is increasing. In 1998, nearly 398,000 people were treated for kidney failure in the United States, costing an average $43,000 per person for a total of $16.7 billion.

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