Key result
Ramipril slowed GFR decline better than metoprolol or amlodipine in African Americans with renal insufficiency, while lower BP targets (≤92 mm Hg) showed no added benefit over usual targets.
Why the study?
Does ramipril or intensive blood pressure lowering slow the rate of glomerular filtration rate decline in African American patients with mild to moderate renal insufficiency?
Population
African American patients with mild to moderate renal insufficiency (hypertensive nephrosclerosis)
Comparison
Ramipril and/or lower mean arterial pressure… vs Metoprolol, amlodipine, and/or usual mean…
Design
Review
Authors
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Supports ACEI preference in African Americans with hypertensive nephrosclerosis; leaves open optimal BP targets pending prospective trials.
RCT
Does ramipril or intensive blood pressure lowering slow the rate of glomerular filtration rate decline in African American patients with mild to moderate renal insufficiency?
Ramipril is superior to metoprolol or amlodipine in slowing renal decline in African Americans with hypertensive nephrosclerosis, whereas intensive blood pressure lowering below usual targets does not provide readily identifiable additional benefits.
Domenic A. Sica (2003) conducted an RCT in Mild to moderate renal insufficiency and hypertensive nephrosclerosis. Ramipril vs. Metoprolol or amlodipine was evaluated on Rate of glomerular filtration rate decline. Ramipril slowed GFR decline better than metoprolol or amlodipine in African Americans with renal insufficiency, while lower BP targets (≤92 mm Hg) showed no added benefit over usual targets.
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