September 1, 1997Hypertension155 citations
Effects of Blood Pressure Control on Progressive Renal Disease in Blacks and Whites
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Key Result
A low mean arterial pressure goal (≤92 mm Hg) slowed GFR decline over 3 years by a mean of 11.8 mL/min in blacks (P=0.11) and 0.3 mL/min in whites (P=0.81) compared to a usual goal (≤107 mm Hg).
Key Points
- The aim is to compare the effects of blood pressure control on renal disease progression between black and white individuals.
- Fifty-three black and 495 white participants were randomly assigned to usual or low mean arterial pressure goals.
- Baseline glomerular filtration rates ranged from 25 to 55 mL/min/1.73 m2.
- Decline in glomerular filtration rate was analyzed in relation to achieved blood pressure levels.
- In blacks, low blood pressure goal resulted in a GFR decline of 11.8+/-7.3 mL/min compared to the usual group (P=.11).
- In whites, the decline was 0.3+/-1.3 mL/min slower with low blood pressure (P=.81).
- Higher achieved blood pressure was linked to faster GFR decline in both groups, with a sevenfold stronger effect in blacks (P<.001).
Study Design
Type
RCT (n=548)
Randomization
randomly assigned
Structured PICO
Does a low mean arterial pressure goal reduce GFR decline in black and white patients with progressive renal disease?
P
Population
548 black and white participants with progressive renal disease and baseline GFRs of 25 to 55 mL/min/1.73 m2, followed for 3 years.
I
Intervention
Low mean arterial pressure (MAP) goal of <= 92 mm Hg
C
Comparator
Usual mean arterial pressure (MAP) goal of <= 107 mm Hg
O
Outcome
Decline in glomerular filtration rate (GFR) over 3 yearssurrogate
A lower blood pressure goal (MAP <= 92 mm Hg) may be particularly important in slowing the progression of renal disease in black patients and those with proteinuria.
Main Result
Effect estimate: 11.8 +/- 7.3 mL/min slower (blacks); 0.3 +/- 1.3 mL/min slower (whites)
p-value: p=0.11 (blacks), 0.81 (whites)
Abstract
African Americans (blacks) have a disproportionately high incidence of end-stage renal disease due to hypertension. The Modification of Diet in Renal Disease (MDRD) Study found that strict blood pressure control slowed the decline in glomerular filtration rate (GFR) only in the subgroup of patients with proteinuria. The present report compares the effects of blood pressure control in black and white MDRD Study participants. Fifty-three black and 495 white participants with baseline GFRs of 25 to 55 mL/min/1.73 m2 were randomly assigned to a usual or low mean arterial pressure (MAP) goal of 1 g/d). In addition, a lower level of blood pressure control may be even more important in blacks than in whites in slowing the progression of renal disease.
Cite This Study
Hebert et al. (1997) conducted an RCT in Progressive Renal Disease (n=548). Low mean arterial pressure (MAP) goal vs. Usual MAP goal of <= 107 mm Hg was evaluated on GFR decline over 3 years (11.8 +/- 7.3 mL/min slower (blacks); 0.3 +/- 1.3 mL/min slower (whites), p=0.11 (blacks), 0.81 (whites)). A low mean arterial pressure goal (≤92 mm Hg) slowed GFR decline over 3 years by a mean of 11.8 mL/min in blacks (P=0.11) and 0.3 mL/min in whites (P=0.81) compared to a usual goal (≤107 mm Hg).