Which Antihypertensive Agents in Chronic Kidney Disease?
Authors: Andrew S. Levey, Katrin Uhlig
Journal: Annals of Internal Medicine (2006)

Editorials7 February 2006Which Antihypertensive Agents in Chronic Kidney Disease?Andrew S. Levey, MD and Katrin Uhlig, MD, MSAndrew S. Levey, MDFrom Tufts-New England Medical Center, Boston, MA 02111 and Katrin Uhlig, MD, MSFrom Tufts-New England Medical Center, Boston, MA 02111Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-3-200602070-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hypertension is common in chronic kidney disease and is a risk factor for progressive loss of kidney function and kidney failure, as well as cardiovascular disease (CVD) (1, 2). In this issue, Rahman and colleagues (3) report the outcomes of CVD in a subgroup of patients with chronic kidney disease from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). The outcomes of kidney disease in the same subgroup were previously reported (4). These reports are important because 17% of ALLHAT participants had chronic kidney disease, making it the largest study of hypertension treatment in patients with this ...References1. National Kidney Foundation. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43:S1-290. [PMID: 15114537] MedlineGoogle Scholar2. Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139:137-47. [PMID: 12859163] LinkGoogle Scholar3. Rahman M, Pressel S, Davis BR, Nwachuku C, Wright JT, Whelton PK, et al. Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Ann Intern Med. 2006;144:172-80. LinkGoogle Scholar4. Rahman M, Pressel S, Davis BR, Nwachuku C, Wright JT, Whelton PK, et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med. 2005;165:936-46. [PMID: 15851647] CrossrefMedlineGoogle Scholar5. Strippoli GF, Craig M, Deeks JJ, Schena FP, Craig JC. Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review. BMJ. 2004;329:828. [PMID: 15459003] CrossrefMedlineGoogle Scholar6. Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med. 2001;135:73-87. [PMID: 11453706] LinkGoogle Scholar7. ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-97. [PMID: 12479763] CrossrefMedlineGoogle Scholar8. Davis BR, Furberg CD, Wright JT, Cutler JA, Whelton P. ALLHAT: setting the record straight. Ann Intern Med. 2004;141:39-46. [PMID: 15238369] LinkGoogle Scholar9. Kramer HJ, Nguyen QD, Curhan G, Hsu CY. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA. 2003;289:3273-7. [PMID: 12824208] CrossrefMedlineGoogle Scholar10. Garg AX, Kiberd BA, Clark WF, Haynes RB, Clase CM. Albuminuria and renal insufficiency prevalence guides population screening: results from the NHANES III. Kidney Int. 2002;61:2165-75. [PMID: 12028457] CrossrefMedlineGoogle Scholar11. Jafar TH, Stark PC, Schmid CH, Landa M, Maschio G, de Jong PE, et al. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med. 2003;139:244-52. [PMID: 12965979] LinkGoogle Scholar12. Mulrow CD, Townsend RR. Guiding lights for antihypertensive treatment in patients with nondiabetic chronic renal disease: proteinuria and blood pressure levels? [Editorial]. Ann Intern Med. 2003;139:296-8. [PMID: 12965986] LinkGoogle Scholar13. The National Heart, Lung, and Blood Institute Working Group on Future Directions in Hypertension Treatment Trials. Major clinical trials of hypertension: What should be done next? Hypertension. 2005;46:1-6. [PMID: 15911739] CrossrefMedlineGoogle Scholar14. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72. 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[PMID: 15998758] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Andrew S. Levey, MD; Katrin Uhlig, MD, MSAffiliations: From Tufts-New England Medical Center, Boston, MA 02111Note: Dr. Levey was the Work Group Chair and Dr. Uhlig was the Assistant Director of the Evidence Review Team for the National Kidney Foundation K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease (1).Acknowledgments: The authors thank Sara L. Pressel, MS, Barry R. Davis, MD, PhD, Jeffrey A. Cutler, MD, MPH, and Mahboob Rahman, MD, MS for providing additional data from ALLHAT; Panagiotis Vlagpoulos, MD, Mei Chung, MPH, and Joseph Lau, MD, for assistance in data synthesis; and Rebecca Persson for editorial assistance.Disclosures: None disclosed.Corresponding Author: Katrin Uhlig, MD, MS, Division of Nephrology, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111; e-mail, [email protected]org.Current Author Addresses: Drs. Levey and Uhlig: Division of Nephrology, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCardiovascular Outcomes in High-Risk Hypertensive Patients Stratified by Baseline Glomerular Filtration Rate Mahboob Rahman , Sara Pressel , Barry R. Davis , Chuke Nwachuku , Jackson T. Wright Jr. , Paul K. Whelton , Joshua Barzilay , Vecihi Batuman , John H. Eckfeldt , Michael A. Farber , Stanley Franklin , Mario Henriquez , Nelson Kopyt , Gail T. Louis , Mohammad Saklayen , Carole Stanford , Candace Walworth , Harry Ward , and Thomas Wiegmann , for the ALLHAT Collaborative Research Group*Correction: Which Antihypertensive Agents in Chronic Kidney Disease? Metrics Cited byCaring for patients with kidney disease: shifting the paradigm from evidence-based medicine to patient-centered careChronic kidney diseaseChronic Kidney Disease in the ElderlyProteinuria as a Surrogate Outcome in CKD: Report of a Scientific Workshop Sponsored by the National Kidney Foundation and the US Food and Drug AdministrationCurrent Guidelines for Using Angiotensin-Converting Enzyme Inhibitors and Angiotensin II–Receptor Antagonists in Chronic Kidney Disease: Is the Evidence Base Relevant to Older Adults?Ann M. O'Hare, MD, James S. Kaufman, MD, Kenneth E. Covinsky, MD, MPH, C. Seth Landefeld, MD, Lynne V. McFarland, PhD, and Eric B. Larson, MD, MPHHypertension and DiabetesDiuretics Are Preferred Over Angiotensin II-Converting Enzyme Inhibitors For Initial Therapy of Uncomplicated HypertensionProgression Risk, Urinary Protein Excretion, and Treatment Effects of Angiotensin-Converting Enzyme Inhibitors in Nondiabetic Kidney DiseaseTreating Hypertension in the Patient With Overt Diabetic NephropathyACE-I and ARB and Blood Pressure Lowering, Including Effect on Renal Disease. Treatment of Advanced Diabetic Renal DiseaseCalcium Channels Blockers and Progression of Kidney DiseaseRenoprotection by blocking the RAAS in diabetic nephropathy—fact or fiction?Correction: Which Antihypertensive Agents in Chronic Kidney Disease? 7 February 2006Volume 144, Issue 3Page: 213-215KeywordsACE inhibitorsBlood pressureCardiovascular diseasesChronic kidney diseaseCongenital heart diseaseDiureticsHypertensionProteinuriaRenal diseasesRenal failure ePublished: 7 February 2006 Issue Published: 7 February 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...