Cook County (Stroger) Hospital, Division of Nephrology, Department of Medicine, Chicago, IL 60612, USA.
Expert Opin Pharmacother. 2010 Nov;11(16):2675-86. doi: 10.1517/14656566.2010.485612. Epub 2010 Aug 18.
A worldwide epidemic of chronic kidney disease (CKD) exists; hypertensive nephropathy is second only to diabetes as a leading cause of progressive CKD. Due to the increasing morbidity and mortality and escalating costs associated with end-stage renal disease (ESRD), novel therapeutic strategies are needed urgently to maximally reduce albuminuria, control blood pressure, and delay progression of hypertensive nephropathy to ESRD. In particular, rational use of renin-angiotensin-aldosterone (RAAS) blockers and achieving blood pressure targets are crucial to reduce cardiovascular and renal outcomes.
We discuss the pathophysiology of hypertensive nephropathy and review current research evidence in support of i) albuminuria reduction as a key factor to maximally slow CKD progression, ii) the blood pressure (BP) goal of < 130 mmHg, and iii) strategies for prevention and optimal treatment of hypertensive nephropathy.
Insight into the complexity of treating patients with hypertensive nephropathy and the effective strategies required for reducing albuminuria, achieving BP goals and delaying progression of hypertensive nephropathy.
Patients with hypertensive proteinuric nephropathy need aggressive BP-lowering with multiple agents that should include RAAS blockers, calcium antagonists and diuretics to maximally slow progression to ESRD.
慢性肾脏病（CKD）在全球范围内流行；高血压肾病是仅次于糖尿病的导致进行性 CKD 的主要原因。由于终末期肾病（ESRD）相关的发病率、死亡率和成本不断上升，迫切需要新的治疗策略，以最大限度地减少蛋白尿、控制血压并延缓高血压肾病向 ESRD 的进展。特别是，合理使用肾素-血管紧张素-醛固酮（RAAS）阻滞剂并达到血压目标对于降低心血管和肾脏结局至关重要。
我们讨论了高血压肾病的病理生理学，并回顾了目前支持以下观点的研究证据：i）降低蛋白尿是最大限度减缓 CKD 进展的关键因素，ii）血压（BP）目标<130mmHg，以及 iii）预防和最佳治疗高血压肾病的策略。
深入了解治疗高血压肾病患者的复杂性以及降低蛋白尿、实现血压目标和延缓高血压肾病进展所需的有效策略。
患有高血压蛋白尿性肾病的患者需要用多种药物积极降压，其中应包括 RAAS 阻滞剂、钙拮抗剂和利尿剂，以最大限度地减缓向 ESRD 的进展。
