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Robert Toto –
Is there really a drug to prevent progressive renal failure in hypertension
(AASK study)
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Overall answer –
NO, but an ACE inhibitor based regimen preferred.
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AASK –
amlodipine vs ramipril vs metoprolol XL aiming to achieve a MAP of 102-107 or
MAP < 92
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Non diabetic
18-70 yo with DBP > 85 mm Hg and GFR between 20 and 65 ml/min
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Primary end
point – Rate of Decline in GFR
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Composite
Clinical End Point
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50% or > 25
ml/min drop in GFR
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ESRF
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Death
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BP lower in
amlodipine group by 2 mm Hg
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No difference in
GFR slope in any of the treatment groups
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No change in GFR
in amlodipine vs ramipril if Urinary Protein was less than 300 mg/d. However,
if Uprotein was greater than 300 mg/d, then there was a sharp reduction in
GFR.
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In this group
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Ramipril vs
Amlodipine – 38% risk reduction
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Ramipril vs
metoprolol – 22% risk reduction (P=0.042)
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Metoprolol vs
Amlodipine- 20% risk reduction (P=17)
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