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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.

In contrast with the findings for amlodipine, other studies^3-4 have found a relationship between renal protection and BP control. On the other hand, inhibitors of renin-angiotensin system . . . [Full Text of this Article]

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