Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Implications of ethnicity for the treatment of hypertensive kidney disease, with an emphasis on African Americans

Nature Clinical Practice Nephrology volume 4, pages 538–549 (2008)Cite this article

Abstract

The recognition of chronic kidney disease (CKD) as an important public health issue has fostered an increasing number of strategies to increase CKD awareness and to reduce both the prevalence and the complications of CKD. Despite these advances, end-stage renal disease (ESRD) and cardiovascular events remain the major complications of CKD. Although the ESRD epidemic is attributed in greater part to the increasing rate of diabetes, hypertension remains the second most common reported cause of ESRD and is present in approximately 90% of cases of diabetes-related ESRD. The disproportionately high prevalence of hypertension in ethnic minorities, as well as the difficulty of achieving adequate blood-pressure control in these populations, contributes substantially to the high rate of CKD progression and complications in these groups. Although the role of hypertension as a primary cause of CKD is debated, hypertension is commonly recognized as the most important CKD progression factor. Important differences have been reported in the degree and likelihood of blood-pressure response to antihypertensive medications between ethnic groups, but ethnicity seems to be less important as a determinant of clinical outcomes. In this Review we examine key ethnic variations in hypertensive CKD in terms of pathophysiology, response to antihypertensive therapy, clinical outcomes, and evidence-based recommendations for blood-pressure control, with an emphasis on African Americans.

Key Points

  • Guidelines suggest that renin–angiotensin inhibition should be the initial therapy for hypertension in all patients with chronic kidney disease (CKD); a diuretic and at least one other agent is usually also required to achieve the blood-pressure goal of <130/80 mmHg

  • Ethnicity is associated with many biologic and sociocultural variations that might influence blood pressure, blood-pressure control and the risk and progression of CKD

  • African Americans with hypertension have a higher risk of developing CKD and a faster rate of CKD progression than white patients with hypertension

  • Some studies have reported that African Americans have lower blood-pressure response rates than whites to some antihypertensive agents

  • No clinically relevant ethnic differences in outcomes have been noted in patients with CKD following evidence-based pharmacologic interventions for blood-pressure control; in part, this is because of the paucity of data, which reinforces the need to achieve greater ethnic diversity in clinical trials

  • In addition to considering the evidence base when treating hypertensive CKD, clinicians should pay detailed attention to potential cultural and socioeconomic influences that disproportionately affect adherence among ethnic minority patients

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Key sociocultural determinants of chronic kidney disease.

Similar content being viewed by others

References

  1. Levey AS et al. (2005) Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 67: 2089–2100

    Article  PubMed  Google Scholar 

  2. Coresh J et al. (2007) Prevalence of chronic kidney disease in the United States. JAMA 298: 2038–2047

    Article  CAS  PubMed  Google Scholar 

  3. Hsu CY et al. (2003) Racial differences in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol 14: 2902–2907

    Article  PubMed  Google Scholar 

  4. Li S et al. (2004) Differences between blacks and whites in the incidence of end-stage renal disease and associated risk factors. Adv Ren Replace Ther 11: 5–13

    Article  PubMed  Google Scholar 

  5. Feehally J (2005) Ethnicity and renal disease. Kidney Int 68: 414–424

    Article  PubMed  Google Scholar 

  6. Hajjar I and Kotchen TA (2003) Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 290: 199–206

    Article  PubMed  Google Scholar 

  7. Norris KC and Agodoa LY (2005) Unraveling the racial disparities associated with kidney disease. Kidney Int 68: 914–924

    Article  PubMed  Google Scholar 

  8. Powe NR (2003) To have and have not: health and health care disparities in chronic kidney disease. Kidney Int 64: 763–772

    Article  PubMed  Google Scholar 

  9. Materson BJ et al. (1993) Single-drug therapy for hypertension in men: a comparison of six antihypertensive agents with placebo: the Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. N Engl J Med 328: 914–921

    Article  CAS  PubMed  Google Scholar 

  10. Chobanian AV et al. (2003) The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC7 report. JAMA 289: 2560–2572

    Article  CAS  PubMed  Google Scholar 

  11. Douglas JG et al. (2003) Management of high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med 163: 525–541

    Article  PubMed  Google Scholar 

  12. Saunders E (1990) Tailoring treatment to minority patients. Am J Med 88: 21S–23S

    Article  CAS  PubMed  Google Scholar 

  13. Rosamond W et al. (2008) Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 117: e25–e146

    PubMed  Google Scholar 

  14. Ong KL et al. (2007) Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 49: 69–75

    Article  CAS  PubMed  Google Scholar 

  15. Kramer H et al. (2004) Racial/ethnic differences in hypertension and hypertension treatment and control in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Hypertens 17: 963–970

    Article  PubMed  Google Scholar 

  16. Knight EL et al. (2003) High-normal blood pressure and microalbuminuria. Am J Kidney Dis 41: 588–595

    Article  PubMed  Google Scholar 

  17. Walker WG et al. (1992) Renal function change in hypertensive members of the Multiple Risk Factor Intervention Trial: racial and treatment effects: the MRFIT Research Group. JAMA 268: 3085–3091

    Article  CAS  PubMed  Google Scholar 

  18. US Renal Data System (online 2007) USRDS 2007 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States [http://www.usrds.org/atlas.htm] (accessed 1 July 2008)

  19. Klag MJ et al. (1997) End-stage renal disease in African-American and white men: 16-year MRFIT findings. JAMA 277: 1293–1298

    Article  CAS  PubMed  Google Scholar 

  20. Stehman-Breen CO et al. (2003) Racial differences in early-onset renal disease among young adults: the Coronary Artery Risk Development In Young Adults (CARDIA) study. J Am Soc Nephrol 14: 2352–2357

    Article  PubMed  Google Scholar 

  21. Tarver-Carr ME et al. (2002) Excess risk of chronic kidney disease among African-American versus white subjects in the United States: a population-based study of potential explanatory factors. J Am Soc Nephrol 13: 2363–2370

    Article  PubMed  Google Scholar 

  22. Suthanthiran M et al. (2000) Transforming growth factor-β1 hyperexpression in African-American hypertensives: a novel mediator of hypertension and/or target organ damage. Proc Natl Acad Sci USA 97: 3479–3484

    CAS  PubMed  PubMed Central  Google Scholar 

  23. DeWan AT et al. (2001) A genome scan for renal function among hypertensives: the HyperGEN study. Am J Hum Genet 68: 136–144

    Article  CAS  PubMed  Google Scholar 

  24. Freedman BI (2003) Susceptibility genes for hypertension and renal failure. J Am Soc Nephrol 14 (Suppl 2): S192–S194

    Article  CAS  PubMed  Google Scholar 

  25. Norris KC et al. (2001) Cocaine use, hypertension and end-stage renal disease. Am J Kidney Dis 38: 523–528

    Article  CAS  PubMed  Google Scholar 

  26. Norris KC and Francis CK (2004) Gender and ethnic differences and considerations in cardiovascular risk assessment and prevention in African Americans. In Practical Strategies in Preventing Heart Disease, 415–440 (Eds Wong N. et al.) New York: McGraw-Hill

    Google Scholar 

  27. Wilson TW and Grim CE (1991) Biohistory of slavery and blood pressure differences in blacks today: a hypothesis. Hypertension 17 (Suppl): I122–I128

    CAS  PubMed  Google Scholar 

  28. Curtin PD (1992) The slavery hypothesis for hypertension among African Americans: the historical evidence. Am J Public Health 82: 1681–1686

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Maseko MJ et al. (2006) Salt intake in an urban, developing South African community. Cardiovasc J S Afr 17: 186–191

    PubMed  Google Scholar 

  30. Sever PS et al. (1980) Blood-pressure and its correlates in urban and tribal Africa. Lancet 2: 60–64

    Article  CAS  PubMed  Google Scholar 

  31. Luft FC et al. (1979) Effects of volume expansion and contraction in normotensive whites, blacks, and subjects of different ages. Circulation 59: 643–650

    Article  CAS  PubMed  Google Scholar 

  32. Laffer CL and Elijovich F (2002) Essential hypertension of Caribbean Hispanics: sodium, renin, and response to therapy. J Clin Hypertens (Greenwich) 4: 266–273

    Article  Google Scholar 

  33. Kobori H et al. (2003) Enhancement of intrarenal angiotensinogen in Dahl salt-sensitive rats on high salt diet. Hypertension 41: 592–597

    Article  CAS  PubMed  Google Scholar 

  34. Chandramohan G et al. (2008) Effects of dietary salt on intrarenal angiotensin system, NAD(P)H oxidase, COX-2, MCP-1 and PAI-1 expressions and NF-κB activity in salt-sensitive and -resistant rat kidneys. Am J Nephrol 28: 158–167

    Article  CAS  PubMed  Google Scholar 

  35. Hayakawa H et al. (1997) Endothelial dysfunction and cardiorenal injury in experimental salt-sensitive hypertension: effects of antihypertensive therapy. Circulation 7: 2407–2413

    Article  Google Scholar 

  36. Grim CE et al. (2005) Hyperaldosteronism and hypertension: ethnic differences. Hypertension 45: 766–772

    Article  CAS  PubMed  Google Scholar 

  37. Bianchi G et al. (1995) Alpha-adducin may control blood pressure both in rats and humans. Clin Exp Pharmacol Physiol Suppl 22: S7–S9

    Article  CAS  PubMed  Google Scholar 

  38. Barlassina C et al. (2000) Alpha-adducin polymorphism in hypertensives of South African ancestry. Am J Hypertens 13: 719–723

    Article  CAS  PubMed  Google Scholar 

  39. Tiago AD et al. (2001) Association study of eight candidate genes with renin status in mild-to-moderate hypertension in patients of African ancestry. Cardiovasc J S Afr 12: 75–80

    CAS  PubMed  Google Scholar 

  40. Schork NJ et al. (2000) Lack of association between a biallelic polymorphism in the adducin gene and blood pressure in whites and African Americans. Am J Hypertens 13: 693–698

    Article  CAS  PubMed  Google Scholar 

  41. Persu A et al. (1998) Genetic analysis of the beta subunit of the epithelial Na+ channel in essential hypertension. Hypertension 32: 129–137

    Article  CAS  PubMed  Google Scholar 

  42. Swift PA and Macgregor GA (2004) Genetic variation in the epithelial sodium channel: a risk factor for hypertension in people of African origin. Adv Ren Replace Ther 11: 76–86

    Article  PubMed  Google Scholar 

  43. Nkeh B et al. (2003) T594M variant of the epithelial sodium channel beta-subunit gene and hypertension in individuals of African ancestry in South Africa. Am J Hypertens 16: 847–852

    Article  CAS  PubMed  Google Scholar 

  44. Hollier JM et al. (2006) Epithelial sodium channel allele T594M is not associated with blood pressure or blood pressure response to amiloride. Hypertension 47: 428–433

    Article  CAS  PubMed  Google Scholar 

  45. Tiago AD et al. (2002) Angiotensinogen gene promoter region variant modifies body size–ambulatory blood pressure relations in hypertension. Circulation 106: 1483–1487

    Article  CAS  PubMed  Google Scholar 

  46. Woodiwiss AJ et al. (2006) Functional variants of the angiotensinogen gene determine antihypertensive responses to angiotensin-converting enzyme inhibitors in subjects of African origin. J Hypertens 24: 1057–1064

    Article  CAS  PubMed  Google Scholar 

  47. Bhatnagar V et al. (2007) Angiotensin-converting enzyme gene polymorphism predicts the time-course of blood pressure response to angiotensin converting enzyme inhibition in the AASK trial. J Hypertens 25: 2082–2092

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Martins DS and Norris KC (2003) Diagnosis and treatment of secondary hypertension. I. International Textbook of Cardiology, 553–562 (Eds Crawford MH and DiMarco JP) London: Mosby International Limited

  49. Beeks E et al. (2004) Genetic predisposition to salt-sensitivity: a systematic review. J Hypertens 22: 1243–1249

    Article  CAS  PubMed  Google Scholar 

  50. Thiel BA et al. (2003) A genome-wide linkage analysis investigating the determinants of blood pressure in whites and African Americans. Am J Hypertens 16: 151–153

    Article  PubMed  Google Scholar 

  51. Svetkey LP et al. (1997) Preliminary evidence of linkage of salt sensitivity in Black Americans at the beta 2-adrenergic receptor locus. Hypertension 29: 918–922

    Article  CAS  PubMed  Google Scholar 

  52. Kotchen TA et al. (2002) Identification of hypertension-related QTLs in African American sib pairs. Hypertension 40: 634–639

    Article  CAS  PubMed  Google Scholar 

  53. Zhu H et al. (2006) The G protein-coupled receptor kinase 4 gene modulates stress-induced sodium excretion in black normotensive adolescents. Pediatr Res 60: 440–442

    Article  CAS  PubMed  Google Scholar 

  54. The Henry J. Kaiser Family Foundation (online 1 February 2007) Key facts: race, ethnicity and medical care, 2007 update. [http://www.kff.org/minorityhealth/6069.cfm] (accessed 12 February 2008)

    Google Scholar 

  55. Keppel KG et al. (2002) Trends in racial and ethnic-specific rates for the health status indicators: United States, 1990–98. Healthy People 2000 Stat Notes 1–16

  56. Duru OK et al. (2007) Health insurance status and hypertension monitoring and control in the United States. Am J Hypertens 20: 348–353

    Article  PubMed  Google Scholar 

  57. Lenfant C (2003) Clinical research to clinical practice—lost in translation. N Engl J Med 349: 868–874

    Article  PubMed  Google Scholar 

  58. Blustein J (2008) Who is accountable for racial equity in health care. JAMA 299: 814–816

    Article  CAS  PubMed  Google Scholar 

  59. Norris K and Nissenson AR (2008) Race, gender, and socioeconomic disparities in CKD in the United States. J Am Soc Nephrol 19: 1261–1270

    Article  PubMed  Google Scholar 

  60. Powe NR (2008) Let's get serious about racial and ethnic disparities. J Am Soc Nephrol 19: 1271–1275

    Article  PubMed  Google Scholar 

  61. Smedley BD et al. (Eds; 2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press

    Google Scholar 

  62. Smith DB (2005) Racial and ethnic health disparities and the unfinished civil rights agenda. Health Aff (Millwood) 24: 317–324

    Article  Google Scholar 

  63. Norris K and Nissenson AR (2008) Racial disparities in chronic kidney disease: tragedy, opportunity, or both. Clin J Am Soc Nephrol 3: 314–316

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hebert LA et al. (1997) Effects of blood pressure control on progressive renal disease in blacks and whites: Modification of Diet in Renal Disease Study Group. Hypertension 30: 428–435

    Article  CAS  PubMed  Google Scholar 

  65. Lewis EJ et al. (1993) The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy: the Collaborative Study Group. N Engl J Med 329: 1456–1462

    Article  CAS  PubMed  Google Scholar 

  66. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia) (1997) Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 349: 1857–1863

  67. Mann JF et al. (2001) Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 134: 629–636

    Article  CAS  PubMed  Google Scholar 

  68. Whelton PK et al. (1996) Recruitment experience in the African-American Study of Kidney Disease and Hypertension (AASK) Pilot Study. Control Clin Trials 16: 17S–33S

    Article  Google Scholar 

  69. Wright JT Jr et al. (2002) Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 288: 2421–2431

    Article  CAS  PubMed  Google Scholar 

  70. Agodoa LY et al. (2001) Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: a randomized controlled trial. JAMA 285: 2719–2728

    Article  CAS  PubMed  Google Scholar 

  71. Wright JT Jr et al. (2002) Successful blood pressure control in the African American Study of Kidney Disease and Hypertension. Arch Intern Med 162: 1636–1643

    Article  PubMed  Google Scholar 

  72. Norris K et al. (2006) Cardiovascular Outcomes in the African American Study of Kidney Disease and Hypertension (AASK) trial. Am J Kidney Dis 48: 739–751

    Article  CAS  PubMed  Google Scholar 

  73. Shulman NB et al. (1989) Prognostic value of serum creatinine and effect of treatment of hypertension on renal function: results from the Hypertension Detection and Follow-up Program: the Hypertension Detection and Follow-up Program Cooperative Group. Hypertension 13: I80–I93

    Article  CAS  PubMed  Google Scholar 

  74. Leenen FH et al. (2006) Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension 48: 374–384

    Article  CAS  PubMed  Google Scholar 

  75. Gibbs CR et al. (1999) Angioedema due to ACE inhibitors: increased risk in patients of African origin. Br J Clin Pharmacol 48: 861–865

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Elliott WJ (1996) Higher incidence of discontinuation of angiotensin converting enzyme inhibitors due to cough in black subjects. Clin Pharmacol Ther 60: 582–588

    Article  CAS  PubMed  Google Scholar 

  77. Woo KS and Nicholls MG (1995) High prevalence of persistent cough with angiotensin converting enzyme inhibitors in Chinese. Br J Clin Pharmacol 40: 141–144

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Lewis EJ et al. (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345: 851–860

    Article  CAS  PubMed  Google Scholar 

  79. Brenner BM et al. (2001) Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 345: 861–869

    Article  CAS  PubMed  Google Scholar 

  80. de Zeeuw D et al. (2006) Renal risk and renoprotection among ethnic groups with type 2 diabetic nephropathy: a post hoc analysis of RENAAL. Kidney Int 69: 1675–1682

    Article  CAS  PubMed  Google Scholar 

  81. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (2002) Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 288: 2981–2997

  82. Wright JT Jr et al. (2005) Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA 293: 1595–1608

    Article  CAS  PubMed  Google Scholar 

  83. Rahman M et al. (2005) Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med 165: 936–946

    Article  CAS  PubMed  Google Scholar 

  84. Srivastava S and Beevers DG (2007) Angioplasty for atheromatous renal artery stenosis: current knowledge and trial results awaited. J Hum Hypertens 21: 507–508

    Article  CAS  PubMed  Google Scholar 

  85. Mistry S et al. (2007) Angioplasty and STent for Renal Artery Lesions (ASTRAL trial): rationale, methods and results so far. J Hum Hypertens 21: 511–515

    Article  CAS  PubMed  Google Scholar 

  86. Rocha-Singh K et al. (2005) Evaluation of the safety and effectiveness of renal artery stenting after unsuccessful balloon angioplasty: the ASPIRE-2 study. J Am Coll Cardiol 46: 776–783

    Article  PubMed  Google Scholar 

  87. [No authors listed] (2004) K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease: executive summary. Am J Kidney Dis 43 (Suppl 1): S16–S33

  88. Lea J et al. (2005) The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension. Arch Intern Med 165: 947–953

    Article  PubMed  Google Scholar 

  89. Balamuthusamy S et al. (2008) Renin angiotensin system blockade and cardiovascular outcomes in patients with chronic kidney disease and proteinuria: a meta-analysis. Am Heart J 155: 791–805

    Article  CAS  PubMed  Google Scholar 

  90. Bakris GL et al. (2000) Preserving renal function in adults with hypertension and diabetes: a consensus approach: National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Am J Kidney Dis 36: 646–661

    Article  CAS  PubMed  Google Scholar 

  91. Martins D and Norris K (2004) Hypertension treatment in African Americans: physiology is less important than sociology. Cleve Clin J Med 71: 735–743

    Article  PubMed  Google Scholar 

  92. Cann HM (1998) Human genome diversity. C R Acad Sci III 321: 443–446

    Article  CAS  PubMed  Google Scholar 

  93. Sankar P et al. (2004) Genetic research and health disparities. JAMA 291: 2985–2989

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. Sehgal AR (2004) Overlap between whites and blacks in response to antihypertensive drugs. Hypertension 43: 566–572

    Article  CAS  PubMed  Google Scholar 

  95. Cooper RS and Psaty BM (2005) Should ethnicity serve as the basis for clinical trial design? Diversity and inclusiveness should remain the guiding principles for clinical trials. Circulation 112: 3660–3665; discussion 3665–3666

    Article  PubMed  Google Scholar 

  96. Issa AM (2007) Personalized medicine and the practice of medicine in the 21st century. Mcgill J Med 10: 53–57

    PubMed  PubMed Central  Google Scholar 

  97. UK Prospective Diabetes Study Group (1998) Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 317: 713–720

    Article  PubMed Central  Google Scholar 

  98. Jafar TH et al. (2001) Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease: a meta-analysis of patient-level data. Ann Intern Med 135: 73–87

    Article  CAS  PubMed  Google Scholar 

  99. Nakao N et al. (2003) Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial. Lancet 361: 117–124

    Article  CAS  PubMed  Google Scholar 

  100. Rahman M et al. (2006) Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Ann Intern Med 144: 172–180

    Article  PubMed  Google Scholar 

  101. Bakris GL et al. (2007) Treatment of microalbuminuria in hypertensive subjects with elevated cardiovascular risk: results of the IMPROVE trial. Kidney Int 72: 879–885

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Support for this article was provided in part by the National Center for Research Resources, Research Centers in Minority Institutions (RR11145 to KCN, NT and DM; and U54 RR019234 to KCN, NT, DM, and NDV), and the DREW/UCLA Project EXPORT, National Institutes of Health, National Center on Minority Health & Health Disparities (P20-MD00182 to KCN).

Author information

Authors and Affiliations

  1. KC Norris is Professor of Medicine and Executive Vice President for Health Affairs and Research, N Tareen is a Nephrologist and Assistant Professor of Medicine and D Martins is an Internist and Assistant Professor of Medicine at Charles Drew University of Medicine and Science, Los Angeles,

    Keith C Norris, Naureen Tareen & David Martins

  2. Physiology and Biophysics and Director of the Division of Nephrology and Hypertension at the University of California, ND Vaziri is Professor of Medicine, Irvine, CA, USA.,

    Nosratola D Vaziri

Authors
  1. Keith C Norris
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naureen Tareen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nosratola D Vaziri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keith C Norris.

Ethics declarations

Competing interests

KC Norris has acted as a consultant for Amgen and Abbott, has received grant/research support from Monarch Pharmaceuticals and has been on speakers' bureaux for Abbott, Amgen, Merck, Monarch and Pfizer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Norris, K., Tareen, N., Martins, D. et al. Implications of ethnicity for the treatment of hypertensive kidney disease, with an emphasis on African Americans. Nat Rev Nephrol 4, 538–549 (2008). https://doi.org/10.1038/ncpneph0909

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneph0909

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing