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Quality of life in the African American Study of Kidney Disease and Hypertension: effects of blood pressure management.

Lash JP, Wang X, Greene T, Gadegbeku CA, Hall Y, Jones K, Kusek JW, Sika M, Unruh M, African American Study of Kidney Disease and Hypertension Trial Study Group
Am J Kidney Dis. 2006 47 (6): 956-64

PMID: 16731290 · DOI:10.1053/j.ajkd.2006.02.175

BACKGROUND - The African American Study of Kidney Disease and Hypertension was a multicenter trial comparing the effects of 2 levels of blood pressure control (usual or low goal) and initial therapy with metoprolol, ramipril, or amlodipine. We examined effects of treatment-group assignment on health-related quality of life (HRQOL) measures and reported symptoms during 4 years of follow-up.

METHODS - HRQOL was assessed at baseline and annually by using the Medical Outcomes Study 36-Item Short Form (SF-36) and a symptom checklist. Using a 2-slope model, treatment effects were evaluated for change from baseline to year 1 and for average change during the first 4 years of follow-up.

RESULTS - A total of 1,094 participants were randomly assigned. Average age was 55 years, 61% were men, and the mean of the first glomerular filtration rate in the study was 46 mL/min/1.73 m2 (0.76 mL/s). No significant differences in HRQOL were seen between the low- and usual-blood-pressure groups. Reported side effects also were similar between blood-pressure groups. Mean Physical Health Component (PHC) and Mental Health Component (MHC) scores had a significantly smaller decrease in the ramipril than metoprolol group in both the initial period from baseline to year 1 (PHC, 2.08 +/- 0.56; MHC, 1.89 +/- 0.62) and during the first 4 years of follow-up (PHC, 1.60 +/- 0.44; MHC, 1.48 +/- 0.48). The MHC also had a slightly smaller decrease during the first 4 years in the ramipril group than amlodipine group (1.20 +/- 0.61).

CONCLUSION - Aggressive blood pressure control is well tolerated in African Americans with hypertensive kidney disease, measured by using the SF-36 and reported symptoms. The clinical significance of smaller decreases in PHC and MHC scores in the ramipril compared with metoprolol group is not clear.

MeSH Terms (18)

Adolescent Adult African Americans Aged Amlodipine Antihypertensive Agents Blood Pressure Female Humans Hypertension Kidney Diseases Male Metoprolol Middle Aged Nephrosclerosis Outcome Assessment, Health Care Quality of Life Ramipril

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