Hypertension is a major contributor to cardiovascular morbidity and
mortality in industrialized countries. During the last 3 decades, multiple
prospective randomized trials, reported individually or in meta-analyses,1 demonstrated a dramatic reduction of vascular events
attributable to hypertension. At the same time, however, the incidence of
end-stage renal disease (ESRD) and congestive heart failure (CHF) has steadily
increased.2,3 African Americans
are particularly affected by these trends, since they have a higher prevalence
and exhibit more severe forms of hypertension, resulting in higher rates of
vascular complications. In particular, ESRD attributable to hypertension has
increased at a rate that is several-fold higher among African American patients
than white patients.4 Although tight blood
pressure control is known to be a crucial factor in preventing progression
of renal disease, other factors are undoubtedly involved. The potential renal
protective effect of specific pharmacologic therapy has been addressed in
only a few studies. Recently published reports indicate benefits from angiotensin-converting
enzyme inhibitor (ACEI) therapy in patients with diabetes and in those with
proteinuria without diabetes,5,6
but these studies included mostly white patients.
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