KIDNEY DISEASE AND HYPERTENSION IN AFRICAN AMERICANS

临床和实验数据表明，适当控制 高血压可降低肾小球滤过率下降率 在包括患有高血压相关肾脏的非裔美国人的患者中 疾病。因此，美国国立卫生研究院正在发起一项 多中心临床试验，非裔美国人肾脏疾病研究 和高血压，来检验严格控制血液的假设 非裔美国人的压力将延缓肾功能衰竭的进展 高血压相关肾脏临床分期的终末期 疾病。这项研究的具体目的有两个： (1)确定三类降压药中的哪一类(钙 通道阻滞剂，血管紧张素转换酶抑制剂，或β- 阻滞剂)在降低血压和降低心率方面最有效 肾功能下降；以及 (2)确定最佳的血压控制水平[平均 动脉压(MAP)小于或等于92毫米汞柱，而MAP介于 102和107毫米汞柱]，以实现有效减少GFR的下降。 要纳入这项研究，患者必须是非洲裔美国人男性和 女性，年龄18-70岁，有高血压和一定程度的肾功能减退 功能。至少三分之一的研究人群必须是女性。 坐位时的舒张压必须为95毫米汞柱或以上 大于和测量的初始GFR必须在25到70毫升/分钟/1.73之间 平米主要排除标准包括加速或 恶性高血压在进入研究的6个月内，一种已知的 I型或II型糖尿病病史和蛋白尿定量 24小时排泄量超过2.5克/24小时或尿蛋白(mg/dL) 与肌酐(mg/dL)的比率超过2.5。 患者将在最初的24个月内被招募到这项研究中。 这些患者随机接受三种药物方案之一和两种药物方案中的一种 血压控制水平将被跟踪长达48个月。 定期监测血压和肾功能，后者 通过对GFR的测量，将在整个 干预和随访。确保病人安全的几个“停”点 安全性是研究方案的一部分。

Clinical and experimental data suggest that adequate control of hypertension can reduce the rate of decline in glomerular filtration rate in patients including African Americans with hypertension-related renal disease. Therefore, the National Institutes of Health is sponsoring a multi-center clinical trail, the African American Study of Kidney Disease and Hypertension, to test the hypothesis that rigorous control of blood pressure in African Americans will retard the progression of renal failure to end-stage in the clinical setting of hypertension-related kidney disease. The specific aims of the study are two-fold: (1) To determine which of three classes of antihypertensive drugs (calcium channel blockers, angiotensin converting enzyme inhibitors, or beta- blockers) is most effective in reducing blood pressure and the rate of decline in kidney function; and (2) To determine the optimum level of blood pressure control [mean arterial pressure (MAP) less than or equal to 92 mmHg versus a MAP between 102 and 107 mmHg] to achieve an effective reduction in the decline in GFR. To be included in the study patients must be African American men and women, age 18-70 years, with hypertension and some degree of reduced renal function. At least one-third of the total study population must be women. The diastolic blood pressure in the sitting position must be 95 mmHg or greater and the measured Initial GFR must be between 25 and 70 ml/min/1.73 sq.m. Major exclusion criteria include a history of accelerated or malignant hypertension within 6 months of entrance into the study, a known history of type I or type II diabetes mellitus, and proteinuria quantified by a 24 hr excretion greater than 2.5 g/24 hr or a urine protein (mg/dL) to creatinine (mg/dL) ratio exceeding 2.5. Patients will be recruited to the study during the initial 24 months. Those randomized to one of the three drug regimens and one of the two levels of blood pressure control will be followed for up to 48 months. Regular monitoring of blood pressure and renal function, the latter through measurement of the GfR, will continue throughout the period of intervention and follow-up. Several "stop" points to ensure patient safety ar built into the study protocol.