Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
J Hum Hypertens. 2011 Apr;25(4):211-7. doi: 10.1038/jhh.2010.64. Epub 2010 Jul 1.
As a consequence of the aging population and the increasing prevalence rates for conditions such as type 2 diabetes and chronic kidney disease (CKD), management of hypertension will be focusing more and more on the high-risk patient. Clinical practice guidelines for managing hypertension in the United States recommend a target blood pressure (BP) <130/80 mm Hg in patients with diabetes or CKD, notably lower than the 140/90-mm Hg threshold for the general hypertensive population. However, the optimal timeframe from initiation of antihypertensive therapy to attaining these levels of BP control and influencing cardiovascular outcomes is not as well defined. Overall, a series of landmark BP intervention trials in patients with hypertension and additional cardiovascular risk factors collectively support that achieving prompt BP control, ideally within 1-3 months, translates into improved cardiovascular outcomes. Although the consistency of the findings is encouraging, the strength of this conclusion is limited by the available data, which were derived from studies not designed to determine the definition or benefits of early BP reduction. In several of these studies, using a treatment approach with initial monotherapy or combination therapy has clearly demonstrated pronounced BP lowering and high BP control rates within an intensive timeframe of 3-6 months of therapy. Although these studies were not conducted exclusively in high-risk patients, subgroup analyses have demonstrated that the observed outcomes in the overall study populations apply to the diabetic and CKD subsets.
随着人口老龄化和 2 型糖尿病和慢性肾脏病 (CKD) 等疾病患病率的增加，高血压的管理将越来越关注高危患者。美国管理高血压的临床实践指南建议，糖尿病或 CKD 患者的目标血压 (BP) <130/80mmHg，明显低于一般高血压人群的 140/90mmHg 阈值。然而，从开始抗高血压治疗到达到这些血压控制水平并影响心血管结局的最佳时间框架尚未明确。总体而言，一系列具有里程碑意义的高血压和其他心血管危险因素患者的 BP 干预试验共同支持这样一种观点，即尽快控制血压（理想情况下在 1-3 个月内）可改善心血管结局。尽管这些发现的一致性令人鼓舞，但由于缺乏旨在确定早期 BP 降低的定义或益处的研究数据，该结论的强度受到限制。在这些研究中，使用初始单药治疗或联合治疗的治疗方法在治疗的 3-6 个月内明显降低了 BP，并实现了较高的 BP 控制率。尽管这些研究并非专门在高危患者中进行，但亚组分析表明，在整个研究人群中观察到的结果适用于糖尿病和 CKD 亚组。
