Department of Medicine, Pritzker School of Medicine, University of Chicago, 924 East 57th Street, Chicago, IL 60637-1455, USA.
Nat Rev Nephrol. 2011 Jan;7(1):11-21. doi: 10.1038/nrneph.2010.154. Epub 2010 Nov 16.
The prevalence of hypertension, chronic kidney disease (CKD) and end-stage renal disease (ESRD) attributable to hypertension continues to rise worldwide. Identifying the precise prevalence of CKD attributable to hypertension is difficult owing to the absence of uniform criteria to establish a diagnosis of hypertensive nephropathy. Despite the increasing prevalence of CKD-associated hypertension, awareness of hypertension among individuals with CKD remains suboptimal and rates of blood-pressure control remain poor. Targeted subgroups involved in studies of CKD seem to reach better rates of blood-pressure control, suggesting that this therapeutic goal can be achieved in patients with CKD. Elevated blood-pressure levels are associated with CKD progression. However, the optimal blood-pressure level and pharmacological agent remains unclear. Physicians treating patients with CKD must recognize the importance of maintaining optimal salt and volume balance to achieve blood-pressure goals. Furthermore, agents that modify the renin-angiotensin-aldosterone axis can be an important adjunct to therapy and physicians must monitor expected changes in serum creatinine and electrolyte levels after their administration. Hypertension remains a common factor complicating CKD. Future investigations identifying early signs of hypertension-related CKD, increasing awareness of the effects of hypertension in CKD and determining optimal therapeutic interventions might help reduce the incidence of hypertensive nephropathy.
高血压、慢性肾脏病（CKD）和高血压引起的终末期肾病（ESRD）的患病率在全球范围内持续上升。由于缺乏建立高血压性肾病诊断的统一标准，因此确定高血压引起的 CKD 的确切患病率具有一定难度。尽管与 CKD 相关的高血压患病率不断增加，但 CKD 患者对高血压的认识仍不理想，血压控制率仍然较低。参与 CKD 研究的目标亚组似乎达到了更好的血压控制率，这表明 CKD 患者可以实现这一治疗目标。血压升高与 CKD 进展有关。然而，最佳血压水平和药物仍不清楚。治疗 CKD 患者的医生必须认识到保持最佳盐和容量平衡以达到血压目标的重要性。此外，可改变肾素-血管紧张素-醛固酮轴的药物可能是治疗的重要辅助手段，医生必须在给药后监测血清肌酐和电解质水平的预期变化。高血压仍然是 CKD 复杂化的常见因素。未来的研究确定与高血压相关的 CKD 的早期迹象，提高对 CKD 中高血压影响的认识，并确定最佳治疗干预措施，可能有助于降低高血压性肾病的发病率。
