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To the Editor: The ALLHAT authors¹ reported that during a 4-year period, glomerular filtration rate (GFR) was best preserved in the patients on amlodipine and declined most in those receiving chlorthalidone. The authors then dismissed this finding by suggesting that the African American Study of Kidney Disease and Hypertension (AASK) study² group had pointed to a detrimental effect of amlodipine on renal function with a faster rate of decline of GFR.

In fact, the AASK study found that the effect of amlodipine on GFR depends on the degree of baseline proteinuria. Thus, patients with a urinary protein-to-creatinine ratio of more than 0.22 showed an immediate and more rapid decline of GFR with amlodipine compared with the groups receiving ramipril or metoprolol. However, this was not the case of the patients with a baseline urinary protein-to-creatinine ratio of less than 0.22; after the 3-year follow-up, such patients on amlodipine had significantly . . . [Full Text of this Article]

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