THE AASK COHORT STUDY

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。尽管血压控制良好，尽管使用了保护肾的抗高血压药物，但高血压相关的肾脏疾病通常会进展。决定这种情况进展的因素仍然知之甚少。AASK队列研究的主要目的是前瞻性地确定接受推荐抗高血压治疗的非裔美国高血压相关肾病患者的肾功能长期病程和肾病进展的危险因素。次要目的是确定心血管疾病的发生，并评估高血压相关肾脏疾病的危险因素。AASK队列研究是一项前瞻性观察性研究，是AASK临床试验的延伸。AASK试验是一项随机临床试验，测试了3种不同的一线降压药物（雷米普利、美托洛尔和氨氯地平）和2种水平的血压控制（常规控制和更积极的控制）的效果。在AASK的1,094名随机参与者中，预计有650-750名未达到ESRD的个体将参加队列研究。此外，在AASK试验期间到达ESRD的个人将被邀请参加一次DNA采集。对于那些参加队列研究的人，每年两次，大约每6个月，将收集暴露量。暴露将包括环境、遗传、生理和社会经济因素。主要肾脏结局将是由血清肌酐翻倍、ESRD或死亡确定的临床结局。适当的降压治疗（在AASK试验中确定的药物和目标血压水平）将提供给所有没有ESRD的参与者。以这种方式，该队列将直接控制肾脏疾病进展的两个主要“已知”决定因素（高血压治疗和使用肾保护，降压药物），因此将在推荐的降压护理设置中解决其研究目标。我们预计每位参与者每年至少有4个联系人，最多6个联系人进行BP控制。队列研究的预期随访时间为5年（总共9-12年，包括AASK试验期间）。假设：假设AASK队列研究将提供数据，增强我们对肾脏疾病进展过程的理解，以及肾脏疾病患者心血管疾病的进展。此外，这项研究的数据可能最终导致新的预防策略，延迟或预防ESRD的发生。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Despite excellent blood pressure control and despite use of reno-protective antihypertensive medication, hypertension-related renal disease commonly progresses. The factors that determine the progression of this condition remain poorly understood. The primary objective of the AASK Cohort Study is to determine prospectively the long-term course of kidney function and risk factors for kidney disease progression in African-Americans with hypertension-related kidney disease that receive recommended antihypertensive therapy. A secondary objective is to determine the occurrence of cardiovascular disease and assess its risk factors in the setting of hypertension-related kidney disease. The AASK Cohort Study is a prospective, observational study that is an extension of the AASK clinical trial. The AASK trial was a randomized, clinical trial that tested the effects of 3 different medications used as first line antihypertensive therapy (ramipril, metoprolol and amlodipine) and 2 levels of blood pressure control (usual control and more aggressive control). Of the 1,094 randomized participants in AASK, it is anticipated that 650-750 individuals who have not reached ESRD will enroll in the Cohort Study. In addition, those individuals who reached ESRD during the AASK trial will be invited to attend one visit for collection of DNA. For those who enroll in the Cohort Study, twice each year, approximately every 6 months, exposures will be collected. Exposures will include environmental, genetic, physiologic, and socio-economic factors. The primary renal outcome will be a clinical outcome defined by doubling of serum creatinine, ESRD or death. Appropriate antihypertensive treatment (medications and target BP level as determined in the AASK trial) will be provided to all participants who do not have ESRD. In this fashion, the cohort will directly control two of the major 'known' determinants of kidney disease progression (treatment of hypertension and use of reno-protective, antihypertensive medication) and will therefore address its research objectives in the setting of recommended antihypertensive care. We anticipate a minimum of 4 contacts and maximum of 6 contacts for BP control per participant per year. The anticipated duration of follow-up in the Cohort Study will be 5 years (total of 9-12 years, including the period of the AASK trial). Hypothesis: It is hypotesized that the AASK Cohort Study will provide data that enhance our understanding of the processes that determine progression of renal disease, and the progression of cardiovascular diusease in renal disease patients. Furthermore, data from this study might ultimately lead to new prevention strategies that delay or prevent the onset of ESRD.