***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 Incidence of end-stage renal disease due to hypertension has increased in recent decades , but the optimal strategy for treatment of hypertension to prevent renal failure is unknown , especially among African Americans . OBJECTIVE To compare the effects of an angiotensin-converting enzyme ( ACE ) inhibitor ( ramipril ) , a dihydropyridine calcium channel blocker ( amlodipine ) , and a beta-blocker ( metoprolol ) on hypertensive renal disease progression . DESIGN , SETTING , AND PARTICIPANTS Interim analysis of a r and omized , double-blind , 3 x 2 factorial trial conducted in 1094 African Americans aged 18 to 70 years with hypertensive renal disease ( glomerular filtration rate [ GFR ] of 20 - 65 mL/min per 1.73 m(2 ) ) enrolled between February 1995 and September 1998 . This report compares the ramipril and amlodipine groups following discontinuation of the amlodipine intervention in September 2000 . INTERVENTIONS Participants were r and omly assigned to receive amlodipine , 5 to 10 mg/d ( n = 217 ) , ramipril , 2.5 to 10 mg/d ( n = 436 ) , or metoprolol , 50 to 200 mg/d ( n = 441 ) , with other agents added to achieve 1 of 2 blood pressure goals . MAIN OUTCOME MEASURES The primary outcome measure was the rate of change in GFR ; the main secondary outcome was a composite index of the clinical end points of reduction in GFR of more than 50 % or 25 mL/min per 1.73 m(2 ) , end-stage renal disease , or death . RESULTS Among participants with a urinary protein to creatinine ratio of > 0.22 ( corresponding approximately to proteinuria of more than 300 mg/d ) , the ramipril group had a 36 % ( 2.02 [ SE , 0.74 ] mL/min per 1.73 m(2)/y ) slower mean decline in GFR over 3 years ( P = .006 ) and a 48 % reduced risk of the clinical end points vs the amlodipine group ( 95 % confidence interval [ CI ] , 20%-66 % ) . In the entire cohort , there was no significant difference in mean GFR decline from baseline to 3 years between treatment groups ( P = .38 ) . However , compared with the amlodipine group , after adjustment for baseline covariates the ramipril group had a 38 % reduced risk of clinical end points ( 95 % CI , 13%-56 % ) , a 36 % slower mean decline in GFR after 3 months ( P = .002 ) , and less proteinuria ( P<.001 ) . CONCLUSION Ramipril , compared with amlodipine , retards renal disease progression in patients with hypertensive renal disease and proteinuria and may offer benefit to patients without proteinuria OBJECTIVE To evaluate the within-trial effect of losartan and conventional antihypertensive therapy ( CT ) compared with placebo and CT on the economic cost associated with end-stage renal disease ( ESRD ) .  RESEARCH DESIGN AND METHODS The Reduction of End Points in Type 2 Diabetes With the Angiotensin II Antagonist Losartan ( RENAAL ) study was a multinational double-blind r and omized placebo-controlled clinical trial design ed to evaluate the renal protective effects of losartan on a background of CT ( excluding ACE inhibitors and angiotensin II receptor agonists [ AIIAs ] ) in patients with type 2 diabetes and nephropathy . The primary composite end point was doubling of serum creatinine , ESRD , or death . Data on the duration of ESRD were used to estimate the economic benefits of slowing the progression of nephropathy . The cost associated with ESRD was estimated by combining the days each patient experienced ESRD with the cost of ESRD over time . The cost of ESRD for individuals with diabetes was estimated using data from the U.S. Renal Data System . Total cost was estimated as the sum of the cost associated with ESRD and the cost of study therapy . RESULTS -We estimated that losartan and CT compared with placebo and CT reduced the number of days with ESRD by 33.6 per patient over 3.5 years ( P = 0.004 , 95 % CI 10.9 - 56.3 ) . This reduction in ESRD days result ed in a decrease in cost associated with ESRD of 5144 US dollars per patient ( P = 0.003 , 95 % CI 1701 to 8587 US dollars ) . After accounting for the cost of losartan , the reduction in ESRD days result ed in a net savings of 3522 US dollars per patient over 3.5 years ( P = 0.041 , 143 to 6900 US dollars ) . CONCLUSIONS Treatment with  losartan in patients with type 2 diabetes and nephropathy not only reduced the incidence of ESRD , but also result ed in substantial cost savings 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 Our study compared the effects of an angiotensin-converting enzyme inhibitor ( captopril ) versus a calcium antagonist ( nifedipine ) on proteinuria and renal function in patients with diabetic nephropathy . A r and omized follow-up study was design ed . Type 2 diabetic patients , with established diabetic nephropathy ( proteinuria greater than 0.5 g/24 h ) , were treated with nifedipine ( 10 patients , group A ) or captopril ( 10 patients , group B ) for 6 months . Arterial blood pressure , metabolic parameters , proteinuria and renal function were measured and compared . Mean percentage differences for glomerular filtration rate , renal plasma flow and filtration fraction between the two groups were calculated . No significant differences were observed in serum glucose , glycosylated hemoglobin ( hemoglobin A1c ) , Na+ , K+ or albumin in either group or between groups . Blood pressure decreased significantly with both treatments and mean blood pressure was significantly lower in group A compared with group B at 6 months ( Mann-Whitney U-test , P = 0.03 ) . Proteinuria was similar in both groups at r and omization , but after 3 and 6 months of treatment significant reductions were observed only in the group treated with captopril ( P less than 0.01 ) . A significant decrease in filtration fraction was observed in group B with an increase in group A ( Mann-Whitney U-test , P = 0.03 ) . Multiple regression analysis identified the therapeutic agent administered as an independent variable for decrease in proteinuria . It is concluded that antihypertensive treatment with captopril , but not with nifedipine , reduced proteinuria in patients with diabetic nephropathy , although a better mean blood pressure was obtained with nifedipine . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES The goal of this study was to determine whether the level of kidney function  is an independent risk factor for atherosclerotic cardiovascular disease ( ASCVD ) outcomes in the Atherosclerosis Risk in Communities ( ARIC ) study , a prospect i ve cohort study of subjects aged 45 to 64 years . BACKGROUND The level of kidney function is now recognized as a risk factor for ASCVD outcomes in patients at high risk for ASCVD , but it remains unknown whether the level of kidney function is a risk factor for ASCVD outcomes in the community . METHODS Cox proportional-hazards regression was used to evaluate the association of glomerular filtration rate ( GFR ) with ASCVD after adjustment for the major ASCVD risk factors in 15,350 subjects . We search ed for nonlinear relationships between GFR and ASCVD . RESULTS During a mean follow-up time of 6.2 years , 965 ( 6.3 % ) of subjects had ASCVD events . Subjects with GFR of 15 to 59 ml/min/1.73 m(2 ) ( n = 444 , hazard ratio 1.38 [ 1.02 , 1.87 ] ) and 60 to 89 ml/min/1.73 m(2 ) ( n = 7,665 , hazard ratio 1.16 [ 1.00 , 1.34 ] ) had an increased adjusted risk of ASCVD compared with subjects with GFR of 90 to 150 ml/min/1.73 m(2 ) . Each 10 ml/min/1.73 m(2 ) lower GFR was associated with an adjusted hazard ratio of 1.05 ( 1.02 , 1.09 ) , 1.07 ( 1.01 , 1.12 ) , and 1.06 ( 0.99 , 1.13 ) for ASCVD , de novo ASCVD , and recurrent ASCVD , respectively . A nonlinear model did not fit the data better than a linear model . CONCLUSIONS The level of GFR is an independent risk factor for ASCVD and de novo ASCVD in the ARIC study Angiotensin converting enzyme inhibitors and calcium antagonists are effective agents for controlling high blood pressure in diabetic patients . We selected 30 type II diabetic patients with proteinuria and evaluated the effect of these drugs on renal function and proteinuria . In a double-blind trial , patients received either 40 mg/day enalapril or 40 mg/day nifedipine during 12 months . They also received a hypoproteic diet with 0.8 g/kg wt/day of protein . In the enalapril group ( 10 men and eight women ) , mean arterial blood pressure was 112.0 + /- 12 mm Hg , creatinine clearance was 58.6 + /- 12.4 ml/min , and 24-hour proteinuria was 4.36 + /- 3.23 g/24 hr before treatment . After treatment , mean arterial blood pressure was 82.0 + /- 8.30 mm Hg ( p less than 0.001 ) , creatinine clearance was 66.6 + /- 13.8 ml/min ( NS ) , and 24-hour proteinuria was 0.56 + /- 0.78 g/24 hr ( p less than 0.001 ) . In the nifedipine group ( six men and six women ) , mean arterial blood pressure was 114.0 + /- 8.0 mm Hg , creatinine clearance was 67.8 + /- 19.6 ml/min 
    Output:
    
RESULTS After adjusting for sample size , study length , and baseline value , there were no statistically significant differences in the ability of either class of calcium antagonist to decrease blood pressure .
Consistently greater reductions in proteinuria were associated with the use of NDCAs compared with DCAs , despite no significant differences in blood pressure reduction or presence of diabetes .
This analysis supports ( 1 ) similar efficacy between subclasses of calcium antagonists to lower blood pressure , and ( 2 ) greater reductions in proteinuria by NDCAs compared to DCAs in the presence or absence of diabetes .
Based on these findings , NDCAs , alone or in combination with an angiotensin-converting enzyme ( ACE ) inhibitor or an angiotensin receptor blocker ( ARB ) , are suggested as preferred agents to lower blood pressure in hypertensive patients with nephropathy associated with proteinuria