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"Intensified BP Control Benefits Kids with Chronic Kidney Disease"

"Intensive blood pressure control in children with chronic kidney disease delays progression, reports a New England Journal of Medicine study."

"Researchers in the international ESCAPE trial followed nearly 400 children, about two thirds of whom suffered from renal hypoplasia-dysplasia. All received high doses of the ACE inhibitor ramipril. They were then randomized to either intensified blood pressure control (to under 50 per cent of the normal range, using drugs that do not target the renin-angiotensin system) or to usual control (to the upper ranges of normal, with no added drugs).
After 5 years' follow-up, those receiving intensified BP control showed delayed progression of their kidney disease. About 30% of the intensified group (versus 42 per cent of controls) showed a 50 per cent decline in glomerular filtration rate or progression to end-stage renal disease.
The authors conclude that "the renoprotective effect of intensified blood-pressure control is additive to the potential benefit conferred by high-dose ACE inhibition."

Physician's First Watch for October 22, 2009
David G. Fairchild, MD, MPH, Editor-in-Chief

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