KIDNEY DISEASE AND HYPERTENSION IN AFRICAN AMERICANS

临床和实验数据表明，充分控制 高血压可降低肾小球滤过率的下降率 在包括非裔美国人在内的高血压相关肾功能不全的患者中， 疾病 因此，美国国立卫生研究院正在赞助一项 多中心临床试验，非裔美国人肾病研究 和高血压，以检验严格控制血液的假设， 非裔美国人的血压将延缓肾衰竭的进展 在高血压相关肾脏的临床环境中， 疾病 这项研究的具体目标有两个方面： (1)确定三类抗高血压药物（钙 通道阻滞剂、血管紧张素转换酶抑制剂或β- 阻断剂）在降低血压和 肾功能下降;以及 (2)确定血压控制的最佳水平[平均值 动脉压（MAP）小于或等于92 mmHg与MAP之间 102和107 mmHg]，以有效降低GFR的下降。 要纳入研究，患者必须是非洲裔美国男性， 女性，年龄18-70岁，患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 mmHg或 更大，测量的初始GFR必须在25和70 ml/min/1.73之间 平方米主要排除标准包括加速或 进入研究后6个月内的恶性高血压， I型或II型糖尿病史和定量的蛋白尿 24小时排泄量大于2.5 g/24小时或尿蛋白（mg/dL） 与肌酐（mg/dL）的比值超过2.5。 患者将在最初24个月内入组研究。 那些被随机分配到三种药物方案之一和两种药物方案之一的患者， 将对血压控制水平进行长达48个月的随访。 定期监测血压和肾功能，后者 通过测量GfR，将在整个 干预和后续行动。 几个“停”点，以确保病人 安全性已纳入研究方案。

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.