Black men with mild to moderate hypertension experienced a significant decline in renal function compared with white men (mean reciprocal creatinine slope -0.0090 vs +0.0018 dL/mg/y; P<0.001).
RCT (n=5,524)
randomized
Does special intervention compared to usual care improve renal function in men with mild to moderate hypertension?
Effective blood pressure control is associated with stable or improving renal function in nonblack hypertensive men, but not in black hypertensive men, highlighting racial disparities in renal outcomes.
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) (PPPPP=.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)
W. G. Walker (Wed,) conducted a rct in Mild to moderate hypertension (n=5,524). Special intervention vs. Usual care was evaluated on Change in renal function based on individual reciprocal creatinine slopes. Black men with mild to moderate hypertension experienced a significant decline in renal function compared with white men (mean reciprocal creatinine slope -0.0090 vs +0.0018 dL/mg/y; P<0.001).
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