***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: CONTEXT Few cardiovascular outcome data are available for blacks with hypertension treated with angiotensin-converting enzyme ( ACE ) inhibitors or calcium channel blockers ( CCBs ) . OBJECTIVE To determine whether an ACE inhibitor or CCB is superior to a thiazide-type diuretic in reducing cardiovascular disease ( CVD ) incidence in racial subgroups . DESIGN , SETTING , AND PARTICIPANTS Prespecified subgroup analysis of ALLHAT , a r and omized , double-blind , active-controlled , clinical outcome trial conducted between February 1994 and March 2002 in 33,357 hypertensive US and Canadian patients aged 55 years or older ( 35 % black ) with at least 1 other cardiovascular risk factor . INTERVENTIONS Antihypertensive regimens initiated with a CCB ( amlodipine ) or an ACE inhibitor ( lisinopril ) vs a thiazide-type diuretic ( chlorthalidone ) . Other medications were added to achieve goal blood pressures ( BPs ) less than 140/90 mm Hg . MAIN OUTCOME MEASURES The primary outcome was combined fatal coronary heart disease ( CHD ) or nonfatal myocardial infa rct ion ( MI ) , analyzed by intention-to-treat . Secondary outcomes included all-cause mortality , stroke , combined CVD ( CHD death , nonfatal MI , stroke , angina , coronary revascularization , heart failure [ HF ] , or peripheral vascular disease ) , and end-stage renal disease . RESULTS No significant difference was found between treatment groups for the primary CHD outcome in either racial subgroup . For amlodipine vs chlorthalidone only , HF was the only prespecified clinical outcome that differed significantly ( overall : relative risk [ RR ] , 1.37 ; 95 % confidence interval [ CI ] , 1.24 - 1.51 ; blacks : RR , 1.46 ; 95 % CI , 1.24 - 1.73 ; nonblacks : RR , 1.32 ; 95 % CI , 1.17 - 1.49 ; P<.001 for each comparison ) with no difference in treatment effects by race ( P = .38 for interaction ) . For lisinopril vs chlorthalidone , results differed by race for systolic BP ( greater decrease in blacks with chlorthalidone ) , stroke , and combined CVD outcomes ( P<.001 , P = .01 , and P = .04 , respectively , for interactions ) . In blacks and nonblacks , respectively , the RRs for stroke were 1.40 ( 95 % CI , 1.17 - 1.68 ) and 1.00 ( 95 % CI , 0.85 - 1.17 ) and for combined CVD were 1.19 ( 95 % CI , 1.09 - 1.30 ) and 1.06 ( 95 % CI , 1.00 - 1.13 ) . For HF , the RRs were 1.30 ( 95 % CI , 1.10 - 1.54 ) and 1.13 ( 95 % CI , 1.00 - 1.28 ) , with no significant interaction by race . Time-dependent BP adjustment did not significantly alter differences in outcome for lisinopril vs chlorthalidone in blacks . CONCLUSIONS In blacks and nonblack subgroups , rates were not lower in the amlodipine or lisinopril groups than in the chlorthalidone group for either the primary CHD or any other prespecified clinical outcome , and diuretic-based treatment result ed in the lowest risk of heart failure . While the improved outcomes with chlorthalidone were more pronounced for some outcomes in blacks than in nonblacks , thiazide-type diuretics remain the drugs of choice for initial therapy of hypertension in both black and nonblack hypertensive patients BACKGROUND The incidence and factors associated with hyperkalemia in patients with chronic kidney disease ( CKD ) treated with angiotensin converting enzyme inhibitors ( ACEIs ) and other antihypertensive drugs  was investigated using the African American Study of Kidney Disease and Hypertension ( AASK ) data base . METHODS A total of 1094 nondiabetic adults with hypertensive CKD ( glomerular filtration rate [ GFR ] , 20 - 65 mL/min/1.73 m(2 ) ) were followed for 3.0 to 6.4 years in the AASK trial . Participants were r and omly assigned to ACEI , beta-blocker ( BB ) , or dihydropyridine calcium channel blocker ( CCB ) . The outcome variables for this analysis were a serum potassium level higher than 5.5 mEq/L ( to convert to millimoles per liter , multiply by 1.0 ) , or a clinical center initiated hyperkalemia stop point . RESULTS A total of 6497 potassium measurements were obtained , and 80 events in 51 subjects were identified ( 76 events driven by a central laboratory result and 4 driven by a clinical center-initiated hyperkalemia stop point ) . Compared with a GFR higher than 50 mL/min/1.73 m(2 ) , after multivariable adjustment , the hazard ratio ( HR ) for hyperkalemia in patients with a GFR between 31 and 40 mL/min/1.73 m(2 ) and a GFR lower than 30 mL/min/1.73 m(2 ) was 3.61 ( 95 % confidence interval [ CI ] , 1.42 - 9.18 [ P = .007 ] ) and 6.81 ( 95 % CI , 2.67 - 17.35 [ P < .001 ] ) , respectively ; there was no increased risk of hyperkalemia if GFR was 41 to 50 mL/min/1.73 m(2 ) . Use of ACEIs was associated with more episodes of hyperkalemia compared with CCB use ( HR , 7.00 ; 95 % CI , 2.29 - 21.39 [ P < .001 ] ) and BB group ( HR , 2.85 ; 95 % CI , 1.50 - 5.42 [ P = .001 ] ) . Diuretic use was associated with a 59 % decreased risk of hyperkalemia . CONCLUSIONS In nondiabetic patients with hypertensive CKD treated with ACEIs , the risk of hyperkalemia is small , particularly if baseline and follow-up GFR is higher than 40 mL/min/1.73 m(2 ) . Including a diuretic in the regimen may markedly reduce risk of hyperkalemia Objective To investigate in a r and om comparison the capacity of an angiotensin converting enzyme inhibitor ( fosinopril ) , and that of a long-acting dihydropiridine ( nifedipine GITS ) to modify the decay in renal function in patients with primary renal disease , exhibiting a progressive increase in serum creatinine during the previous 2 years . Methods A r and omized , open-label , multicenter study with a minimum follow-up of 3 years . A total of 241 patients were included in the study . All of them were hypertensive and had a 25 % or at least 0.5 mg/dl increase in the value of serum creatinine during the 24 months prior to entering the study . Initial doses of fosinopril and nifedipine GITS were 10 and 30 mg respectively , and titration to 30 and 60 mg was performed if needed to obtain the expected blood pressure goal ( < 140/90 mmHg ) . Furosemide , atenolol , and doxazosin were added as second , third , and fourth drugs if necessary , for blood pressure control . The primary end-point of the study was the appearance of double the serum creatinine values and /or the need to enter a dialysis programme . Secondary end-points were cardiovascular events , death , changes in 24 h proteinuria , and the evolution of serum creatinine . Data reflect the analysis performed by intention to treat . Results Mean age of the group was 54 ± 14 , and 59 % were males .  Primary glomerulonephritis ( 31 % ) , nephrosclerosis ( 26 % ) and polycystic kidney disease ( 19 % ) were the three most frequent diagnostic findings . After 3 years of follow-up , 21 % ( 27/127 ) of patients treated with fosinopril , and 36 % ( 40/112 ) of those receiving nifedipine GITS presented a primary end-point , ( OR 0.47 , 95 % confidence intervals 0.26–0.84 , P = 0.01 ) . Renal survival was significantly better when fosinopril constituted the first step therapy ( P = 0.002 ) . These results did not seem to be influenced by the type of primary renal disease . Proteinuria decreased at the end of the study by a mean of 57 % in the fosinopril group and increased by 7 % in the group  receiving dihydropiridine . Blood pressure control did not differ among groups for diastolic values . During follow-up , however , the patients receiving ACEi showed systolic blood pressure values 4–6 mmHg lower . Conclusion In patients with chronic renal failure and hypertension due to primary renal disease , fosinopril significantly differed from nifedipine GITS by its capacity to slow the progressive decay in renal function . The drugs also differed by their capacity to lower blood pressure . The better control , in particular of systolic blood pressure , in the fosinopril arm could have contributed in a relevant manner to the attainment of a better outcome when the ACEi was employed BACKGROUND It is unknown whether either the angiotensin-II-receptor blocker irbesartan or the calcium-channel blocker amlodipine slows the progression of nephropathy in patients with type 2 diabetes independently of its capacity to lower the systemic blood pressure . METHODS We r and omly assigned 1715 hypertensive patients with nephropathy due to type 2 diabetes to treatment with irbesartan ( 300 mg daily ) , amlodipine ( 10 mg daily ) , or  placebo .  The target blood pressure was 135/85 mm Hg or less in all groups . We compared the groups with regard to the time to the primary composite end point of a doubling of the base-line serum creatinine concentration , the development of end-stage renal disease , or death from any cause . We also compared them with regard to the time to a secondary , cardiovascular composite end point . RESULTS The mean duration of follow-up was 2.6 years . Treatment with irbesartan was associated with a risk of the primary composite end point that was 20 percent lower than that in the placebo group ( P=0.02 ) and 23 percent lower than that in the amlodipine group ( P=0.006 ) . The risk of a doubling of the serum creatinine concentration was 33 percent lower in the irbesartan group than in the placebo group ( P=0.003 ) and 37 percent lower in the irbesartan group than in the amlodipine group ( P<0.001 ) . Treatment with irbesartan was associated with a relative risk of end-stage renal disease that was 23 percent lower than that in both other groups ( P=0.07 for both comparisons ) . These differences were not explained by differences in the blood pressures that were achieved . The serum creatinine concentration increased 24 percent more slowly in the irbesartan group than in the placebo group ( P=0.008 ) and 21 percent more slowly than in the amlodipine group ( P=0.02 ) . There were no significant differences in the rates of death from any cause or in the cardiovascular composite end point . CONCLUSIONS The angiotensin-II-receptor blocker irbesartan is effective in protecting against the progression of nephropathy due to type 2 diabetes . This protection is independent of the reduction in blood pressure it causes OBJECTIVE ACE inhibitors and calcium antagonists may favorably affect serum lipids and glucose metabolism . The primary aim of the Fosinopril Versus Amlodipine Cardiovascular Events R and omized Trial ( FACET ) was to compare the effects of fosinopril and amlodipine on serum lipids and diabetes control in NIDDM patients with hypertension . Prospect ively defined cardiovascular events were assessed as secondary outcomes . RESEARCH DESIGN AND METHODS Inclusion criteria included a diagnosis of NIDDM and hypertension ( systolic blood pressure of > 140 mmHg or diastolic blood pressure of > 90 mmHg ) . Exclusion criteria included a history of coronary heart disease or stroke , serum creatinine > 1.5 mg/dl , albuminuria > 40 μg/min , and use of lipid-lowering drugs , aspirin , or antihypertensive agents other than beta-blockers or diuretics . A total of 380 hypertensive diabetics were r and omly assigned to open-label fosinopril ( 20 mg/day ) or amlodipine ( 10 mg/day ) and followed for up to 3.5 years . If blood pressure was not controlled , the other study drug was added . RESULTS Both treatments were effective in lowering blood pressure . At the end of followup , between the two groups there was no significant difference in total serum cholesterol , HDL cholesterol , 
    Output:
    
CCBs did not increase all-cause mortality incidence in patients with CKD though they displayed weaker renoprotective , compared to ACEIs or ARBs therapy .
Our results suggest the combination of a CCB and an ACEI or ARB should be a preferable antihypertensive therapy in patients with CKD , considering their higher effect in decreasing blood pressure and fewer adverse metabolic problems caused