This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Racial and Treatment Effects

W. Gordon Walker, MD; James D. Neaton, PhD; Jeffrey A. Cutler, MD; Rachel Neuwirth, MD; Jerome D. Cohen, MD; MRFIT Research Group

JAMA. 1992;268(21):3085-3091.

Abstract
Objective.
—To evaluate the contribution of mild to moderate hypertension to progressive loss of renal function by analysis of renal function data from the Multiple Risk Factor Intervention Trial.

Design.
—The cohort of men with mild to moderate hypertension (baseline diastolic blood pressure 90 mm Hg), randomized to a special intervention (SI) group or usual care (UC) group, were examined for change in renal function based on individual reciprocal creatinine slopes over an average of 7 years' follow-up as the outcome measure. Contribution of blood pressure control during follow-up, age, race, and blood pressure at entry were assessed.

Participants.
—The cohort of 5524(463 black, 5061 nonblack) hypertensive men receiving no therapy at entry provided the data for the present analysis.

Results.
—Blood pressure control was similar for black and white participants, but significant decline in reciprocal creatinine slope was found for black men (mean slope, —0.0090±0.0013 dL/mg/y) compared with white men (+0.0018± 0.0004 dL/mg/y) (P<.001 for difference between blacks and whites). Decline in renal function was also greater among individuals with elevated systolic (P<.001) as well as diastolic blood pressure (P<.001), and older individuals (P<.001). No difference between the SI and UC groups was seen in reciprocal creatinine slopes, but in both groups combined, treatment that maintained diastolic blood pressure below an average value of 95 mm Hg was associated with stable or improving renal function, whereas participants whose blood pressure remained 95 mm Hg or greater continued to decline at —0.0013±0.0009 dL/mg/y (P=.007 for difference). Separate examination of the subset of black men (n=463) failed to show such a difference.

Conclusions.
—Effective blood pressure control was associated with stable or improving renal function in nonblacks but not in blacks. These findings emphasize the importance of blood pressure control to maintain adequate renal function in hypertensive white men and raise important questions about the relationship of pressure reduction and renal function change in blacks.

(JAMA. 1992;268:3085-3091)

Author Affiliations
From the School of Medicine, The Johns Hopkins University, Baltimore, Md (Dr Walker); School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis (Drs Neaton and Neuwirth); Division of Epidemiology and Clinical Applications, National Heart, Lung and Blood Institute, Bethesda, Md (Dr Cutler); and Preventive Cardiology Programs, St Louis University Medical Center, St Louis, Mo (Dr Cohen).

Footnotes
Dr Neuwirth is now with Sandoz Pharmaceuticals

Corporation, East Hanover, NJ.

Participating institutions and investigators in the Multiple Risk Factor Intervention Trial are listed in reference 18.

Reprint requests to Johns Hopkins University School of Medicine, The Good Samaritan Hospital, Professional Office Building, Suite 401, 5601 Loch Raven Blvd, Baltimore, MD 21239 (Dr Walker).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pressure-Induced Renal Injury in Angiotensin II Versus Norepinephrine-Induced Hypertensive Rats
Polichnowski and Cowley
Hypertension 2009;54:1269-1277.
ABSTRACT | FULL TEXT  

Exploration of anaemia as a progression factor in African Americans with cardiovascular disease
Newsome et al.
Nephrol Dial Transplant 2009;24:3404-3411.
ABSTRACT | FULL TEXT  

Hypertension-Associated Kidney Disease: Perhaps no More
Freedman and Sedor
J. Am. Soc. Nephrol. 2008;19:2047-2051.
ABSTRACT | FULL TEXT  

High Perfusion Pressure Accelerates Renal Injury in Salt-Sensitive Hypertension
Mori et al.
J. Am. Soc. Nephrol. 2008;19:1472-1482.
ABSTRACT | FULL TEXT  

Higher Serum Creatinine Concentrations in Black Patients with Chronic Kidney Disease: Beyond Nutritional Status and Body Composition
Hsu et al.
CJASN 2008;3:992-997.
ABSTRACT | FULL TEXT  

Long-term Effects of Renin-Angiotensin System-Blocking Therapy and a Low Blood Pressure Goal on Progression of Hypertensive Chronic Kidney Disease in African Americans
Appel et al.
Arch Intern Med 2008;168:832-839.
ABSTRACT | FULL TEXT  

European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts)
Authors/Task Force Members et al.
Eur Heart J 2007;28:2375-2414.
FULL TEXT  

Renal function and heart failure risk in older black and white individuals: the health, aging, and body composition study.
Bibbins-Domingo et al.
Arch Intern Med 2006;166:1396-1402.
ABSTRACT | FULL TEXT  

Comparison of Methods for Determining Renal Function Decline in Early Autosomal Dominant Polycystic Kidney Disease: The Consortium of Radiologic Imaging Studies of Polycystic Kidney Disease Cohort
Rule et al.
J. Am. Soc. Nephrol. 2006;17:854-862.
ABSTRACT | FULL TEXT  

Impaired Vascular Reactivity in African-American Patients with Type 2 Diabetes Mellitus and Microalbuminuria or Proteinuria Despite Angiotensin-Converting Enzyme Inhibitor Therapy
Jawa et al.
J. Clin. Endocrinol. Metab. 2006;91:31-35.
ABSTRACT | FULL TEXT  

JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice
Prepared by: British Cardiac Society, British Hype
Heart 2005;91:v1-v52.
FULL TEXT  

Essential Hypertension, Progressive Renal Disease, and Uric Acid: A Pathogenetic Link?
Johnson et al.
J. Am. Soc. Nephrol. 2005;16:1909-1919.
ABSTRACT | FULL TEXT  

Control of Hypertension in Adults With Chronic Kidney Disease in the United States
Peralta et al.
Hypertension 2005;45:1119-1124.
ABSTRACT | FULL TEXT  

Race and Renal Impairment in Heart Failure: Mortality in Blacks Versus Whites
Smith et al.
Circulation 2005;111:1270-1277.
ABSTRACT | FULL TEXT  

Role of Pressure in Angiotensin II-Induced Renal Injury: Chronic Servo-Control of Renal Perfusion Pressure in Rats
Mori and Cowley
Hypertension 2004;43:752-759.
ABSTRACT | FULL TEXT  

Effect of Blood Pressure on Early Decline in Kidney Function Among Hypertensive Men
Vupputuri et al.
Hypertension 2003;42:1144-1149.
ABSTRACT | FULL TEXT  

Prevalence of Kidney Damage in Australian Adults: The AusDiab Kidney Study
Chadban et al.
J. Am. Soc. Nephrol. 2003;14:S131-138.
ABSTRACT | FULL TEXT  

Design and Statistical Aspects of the African American Study of Kidney Disease and Hypertension (AASK)
Gassman et al.
J. Am. Soc. Nephrol. 2003;14:S154-165.
ABSTRACT | FULL TEXT  

Progression of Chronic Renal Failure
Yu
Arch Intern Med 2003;163:1417-1429.
ABSTRACT | FULL TEXT  

Effect of Blood Pressure Lowering and Antihypertensive Drug Class on Progression of Hypertensive Kidney Disease: Results From the AASK Trial
Wright et al.
JAMA 2002;288:2421-2431.
ABSTRACT | FULL TEXT  

Hypertension Control and Kidney Disease: Some Questions Answered, Many Remain
Alderman
JAMA 2002;288:2466-2467.
FULL TEXT  

Blood Pressure and Decline in Kidney Function: Findings from the Systolic Hypertension in the Elderly Program (SHEP)
Young et al.
J. Am. Soc. Nephrol. 2002;13:2776-2782.
ABSTRACT | FULL TEXT  

Excess Risk of Chronic Kidney Disease among African-American versus White Subjects in the United States: A Population-Based Study of Potential Explanatory Factors
Tarver-Carr et al.
J. Am. Soc. Nephrol. 2002;13:2363-2370.
ABSTRACT | FULL TEXT  

Prevalence of Low Glomerular Filtration Rate in Nondiabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III)
Clase et al.
J. Am. Soc. Nephrol. 2002;13:1338-1349.
ABSTRACT | FULL TEXT  

The elderly hypertensive population: what lies ahead of us?
Bobrie and Potter
Journal of Renin-Angiotensin-Aldosterone System 2002;3:S4-S9.
 

Factors affecting renal function in 119 985 adults over three years
Ishida et al.
QJM 2001;94:541-550.
ABSTRACT | FULL TEXT  

Predictors of Target Organ Damage in Hypertensive Blacks and Whites
El-Gharbawy et al.
Hypertension 2001;38:761-766.
ABSTRACT | FULL TEXT  

Prevalence of High Blood Pressure and Elevated Serum Creatinine Level in the United States: Findings From the Third National Health and Nutrition Examination Survey (1988-1994)
Coresh et al.
Arch Intern Med 2001;161:1207-1216.
ABSTRACT | FULL TEXT  

Inaccuracy of clinical phenotyping parameters for hypertensive nephrosclerosis
Zarif et al.
Nephrol Dial Transplant 2000;15:1801-1807.
ABSTRACT | FULL TEXT  

Glomerular Hyperfiltration in Hypertensive African Americans
Kotchen et al.
Hypertension 2000;35:822-826.
ABSTRACT | FULL TEXT  

Arterial Hypertension and Renal Allograft Survival
Mange et al.
JAMA 2000;283:633-638.
ABSTRACT | FULL TEXT  

Hypertensive nephrosclerosis: pathogenesis and prevalence : Essential hypertension is an important cause of end-stage renal disease
Luke
Nephrol Dial Transplant 1999;14:2271-2278.
FULL TEXT  

A Community-Based Study of Explanatory Factors for the Excess Risk for Early Renal Function Decline in Blacks vs Whites With Diabetes: The Atherosclerosis Risk in Communities Study
Krop et al.
Arch Intern Med 1999;159:1777-1783.
ABSTRACT | FULL TEXT  

The progression of chronic renal failure: a harmful quartet
El-Nahas and Tamimi
QJM 1999;92:421-424.
FULL TEXT  

Management of chronic renal insufficiency in lupus nephritis: Role of proteinuria, hypertension and dyslipidemia in the progression of renal disease
Clark and Moist
Lupus 1998;7:649-653.
ABSTRACT  

End-stage Renal Disease in Specific Ethnic and Racial Groups: Risk Factors and Benefits of Antihypertensive Therapy
Powers and Wallin
Arch Intern Med 1998;158:793-800.
ABSTRACT | FULL TEXT  

Effects of Blood Pressure Control on Progressive Renal Disease in Blacks and Whites
Hebert et al.
Hypertension 1997;30:428-435.
ABSTRACT | FULL TEXT  

End-stage Renal Disease in African-American and White Men: 16-Year MRFIT Findings
Klag et al.
JAMA 1997;277:1293-1298.
ABSTRACT  

Serum Creatinine Concentration and Risk of Cardiovascular Disease : A Possible Marker for Increased Risk of Stroke
Wannamethee et al.
Stroke 1997;28:557-563.
ABSTRACT | FULL TEXT  

1995 Update of the Working Group Reports on Chronic Renal Failure and Renovascular Hypertension
National High Blood Pressure Education Program Wor
Arch Intern Med 1996;156:1938-1947.
ABSTRACT  

Blood Pressure and End-Stage Renal Disease in Men
Klag et al.
NEJM 1996;334:13-18.
ABSTRACT | FULL TEXT  

Effects of Hypertension and Dyslipidemia on the Decline in Renal Function
Manttari et al.
Hypertension 1995;26:670-675.
ABSTRACT | FULL TEXT  

Salt-Induced Increases in Systolic Blood Pressure Affect Renal Hemodynamics and Proteinuria
Weir et al.
Hypertension 1995;25:1339-1344.
ABSTRACT | FULL TEXT  

Renal Disease in Hypertensive Blacks: MRFIT
Rosansky and Hoover
JAMA 1993;269:2629-2629.
ABSTRACT  

Renal Disease in Hypertensive Blacks: MRFIT
Stockwell and Alderman
JAMA 1993;269:2629-2630.
ABSTRACT  

Projections of Hypertension-Related Renal Disease in Middle-aged Residents of the United States
Perneger et al.
JAMA 1993;269:1272-1277.
ABSTRACT  

Blood Pressure, Systolic and Diastolic, and Cardiovascular Risks: US Population Data
Stamler et al.
Arch Intern Med 1993;153:598-615.
ABSTRACT  

A Prospective Study of Blood Pressure and Serum Creatinine: Results From the 'Clue' Study and the ARIC Study
Perneger et al.
JAMA 1993;269:488-493.
ABSTRACT  

BLACKS HAVE HIGHER RISK OF END-STAGE RENAL DISEASE
JWatch General 1992;1992:1-1.
FULL TEXT  

Can We Prevent End-Stage Renal Disease due to Hypertension or to Diabetes Mellitus?
Luke
JAMA 1992;268:3119-3120.
ABSTRACT