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(Hypertension. 1997;30:428.)
© 1997 American Heart Association, Inc.
Articles |
Effects of Blood Pressure Control on Progressive Renal Disease in Blacks and Whites
Modification of Diet in Renal Disease Study Group1From the National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md.
Correspondence to Gerald Beck, PhD, MDRD Data Coordinating Center, Department of Biostatistics and Epidemiology, P88, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail gbeck{at}bio.ri.ccf.org
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 
107 or 92
mm Hg, respectively. GFR decline was compared between randomized
groups and correlated with the level of achieved blood pressure. The
mean (±SE) GFR decline over 3 years in the low blood pressure group
was 11.8±7.3 mL/min slower than in the usual blood pressure group
among blacks (P=.11) compared with 0.3±1.3 mL/min slower
among whites (P=.81) (P=.12 between blacks and
whites). In both blacks and whites, higher baseline urine protein
excretion was associated with a greater beneficial effect of the low
MAP goal on GFR decline (P=.02 for both races). Combining
both blood pressure groups and controlling for baseline
characteristics, higher follow-up achieved MAP was associated with
faster GFR decline in both blacks (P<.001) and whites
(P=.002), with a sevenfold stronger relationship in blacks
(P<.001). These secondary analyses support the
prior recommendation for a lower than usual blood pressure goal (MAP
92 mm Hg) in black and white patients with proteinuria (>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.
Key Words: renal disease • blood pressure • renal function • proteinuria • race
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