Table III.
Key Points
| Treatment with ramipril was significantly better than amlodipine but not metoprolol in the change in mean chronic GFR slopes in patients with a baseline UP/Cr >0.22 (300 mg protein/day). GFR declined faster in the amlodipine than the metoprolol group during the chronic phase of the study. |
| In the entire cohort, after adjusting for prespecified baseline covariates, ramipril was associated with a risk reduction in the time of progression to the following clinically relevant end points compared with amlodipine: 41% risk reduction for the combination of ESRD or death, and 38% risk reduction for the combination of GFR events, ESRD, or death. The risk reduction for ramipril vs. metoprolol was 22% for the clinical composite end point of a GFR event, ESRD, or death. There was no significant difference between the amlodipine and the metoprolol groups in the main clinical composite outcome. However, the metoprolol group had a significantly lower risk for ESRD or death and for ESRD alone. |
| The reduction in risk of the combined end points of ESRD, death, or GFR was influenced heavily by the subgroup of patients with baseline proteinuria; this subgroup contributed 63% of the events, although it represented only 33% of the cohort. |
| Treatment with amlodipine increased proteinuria by 58% in the first 6 months, whereas metoprolol and ramipril decreased proteinuria by 14% and 20%, respectively. The rate at which UP/Cr <0.22 progressed to >0.22 was 56% lower in the ramipril‐treated group than in the amlodipine group. Moreover, during the first 6 months of the study proteinuria increased by 7% in the usual BP group and decreased by 17% in the lower BP group. These treatment group differences were maintained throughout the study. |
| At the end of the follow‐up, there was no difference in the decline of GFR among patients with no baseline proteinuria or a GFR of at least 40 mL/min per 1.73 m2, which was related to the fact that those in the amlodipine treatment group experienced an acute rise in GFR shortly after beginning therapy. The same finding was observed in comparing metoprolol to amlodipine. |
| GFR=glomerular filtration rate; ESRD=end‐stage renal disease; UP/Cr=urine protein‐creatinine ratio |