ACE Inhibitor Better for Blacks at Risk of Kidney Failure

A study of hypertension and kidney disease in African-Americans has found that a class of high blood pressure medication called ACE inhibitors prevent kidney failure and death better than other drugs currently used for front-line treatment in African Americans.

Posted on June 6, 2001 at 2:10 p.m.

BIRMINGHAM, AL — A study of hypertension and kidney disease in African-Americans has found that a class of high blood pressure medication called ACE inhibitors prevent kidney failure and death better than other drugs currently used for front-line treatment in African Americans. The findings, co-authored by UAB (University of Alabama at Birmingham) researchers, was published today in the Journal of the American Medical Association (JAMA).

Dr. Stephen Rostand, a specialist in kidney disease, says the study will help physicians decide how to treat patients who have hypertension and signs of kidney disease. ACE inhibitors already are recommended for patients with kidney disease caused by diabetes.

Rostand is principal investigator for the UAB arm of the 21-center, African- American Study of Kidney Disease and Hypertension (AASK), which is funded by the National Institutes of Health. He and colleague Dr. Denise Thornley-Brown enrolled 66 participants into the study. Nationally, 1,100 people participated.

African-Americans make up 13.9 percent of the U.S. population, but comprise almost 30 percent of people treated for kidney failure. Better management of high blood pressure has led to fewer strokes and heart disease, but the rate of kidney failure continues to increase.

The JAMA report compared ramipril (Altace®), an ACE (angiotensin-converting enzyme) inhibitor, with amlodipine (Norvasc®), a dihydropyridine calcium channel blocker (CCB). Blood pressure control was comparable between the study groups, but ramipril was better at protecting the kidneys of African Americans from progression to failure. Study participants had high blood pressure and had mild to moderate renal insufficiency due to hypertension. The ACE inhibitor was shown to slow kidney disease by 36 percent and slash the risk of kidney failure and death by 48 percent those subjects with more than 1 gram of protein in the urine. “Calcium channel blockers can be added to a patient’s treatment if a patient’s blood pressure cannot be adequately controlled with ACE inhibitors alone,” Rostand noted.

AASK stopped using the calcium channel blockers as a front-line treatment in September 2000 on the advice of a data and safety monitoring board. AASK investigators will continue to compare the ACE inhibitor with another class of blood pressure drugs called beta blockers (metoprolol, Toprol XL®) and two blood pressure goals until the fall of 2001, when the study will end.