ACE inhibitor has renal protective effect in hypertensive African-Americans

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Last Updated: 2001-07-10 15:13:35 EDT (Reuters Health)

By Joene Hendry

WESTPORT, CT (Reuters Health) – In a population of African-American adults with hypertension-related renal disease, those treated with the ACE-inhibitor ramipril showed a reduced risk of proteinuria when compared with patients treated with the calcium channel blocker amlodipine.

"It was previously thought that ACE inhibitors were less effective in African Americans," Dr. Edgar Miller, of Johns Hopkins University, in Baltimore, told Reuters Health. However, he noted, these findings indicate a renal protective effect of ramipril in the African-American population.

Dr. Miller and Dr. Keith Norris, of Charles R. Drew University, in Los Angeles, presented an interim analysis of the ongoing African-American Study on Kidney Disease (AASK) trial during the 16th annual International Interdisciplinary Conference on Hypertension and Related Risk Factors in Ethnic Populations, in Las Vegas, on Monday.

The AASK trial randomized 1094 African Americans, who had diastolic blood pressure greater than 95 mm Hg and impaired renal function, to hypertensive therapy with ramipril, amlodipine or metoprolol, a beta-blocker (control group). The study patients were equally divided between sexes and were a mean age of 54 years at baseline.

After a median follow-up of 3 years, patients treated with amlodipine had a 56% higher incidence of proteinuria from baseline. In contrast, patients treated with ramipril had a 50% reduced risk of proteinuria, Dr. Miller said. Blood pressure control was similar between the treatment groups.

Compared with patients treated with amlodipine, patients treated with ramipril had a 48% overall reduced risk of the clinical endpoints, which included a 50% reduction in kidney function, end-stage renal disease or death. Dr. Miller also noted that because of these findings, the amlodipine arm of the study was stopped.

The investigators believe these interim results support the use of ACE inhibitors as initial therapy in hypertensive African Americans with chronic renal insufficiency.

-Westport Newsroom 203 319 2700

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