Norris Keith C, Tareen Naureen, Martins David, Vaziri Nosratola D
Charles Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
Nat Clin Pract Nephrol. 2008 Oct;4(10):538-49. doi: 10.1038/ncpneph0909. Epub 2008 Aug 5.
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.
慢性肾脏病（CKD）被视为一个重要的公共卫生问题，这促使人们采取越来越多的策略来提高对CKD的认识，并降低CKD的患病率和并发症。尽管取得了这些进展，但终末期肾病（ESRD）和心血管事件仍然是CKD的主要并发症。虽然ESRD的流行在很大程度上归因于糖尿病发病率的上升，但高血压仍然是ESRD报告的第二大常见病因，并且在约90%的糖尿病相关ESRD病例中存在。少数民族中高血压患病率过高，以及这些人群难以实现充分的血压控制，在很大程度上导致了这些群体中CKD进展和并发症的高发生率。尽管高血压作为CKD主要病因的作用存在争议，但高血压通常被认为是最重要的CKD进展因素。据报道，不同种族之间对抗高血压药物的血压反应程度和可能性存在重要差异，但种族作为临床结局的决定因素似乎不那么重要。在本综述中，我们从病理生理学、对抗高血压治疗的反应、临床结局以及基于证据的血压控制建议等方面，研究高血压性CKD的关键种族差异，重点关注非裔美国人。
