Tufts University School of Medicine, Boston, MA, USA.
Ann Intern Med. 2011 Apr 19;154(8):541-8. doi: 10.7326/0003-4819-154-8-201104190-00335. Epub 2011 Mar 14.
The optimal blood pressure target in patients with chronic kidney disease (CKD) is unclear.
To summarize trials comparing lower versus higher blood pressure targets in adult patients with CKD and focus on proteinuria as an effect modifier.
MEDLINE and the Cochrane Central Register of Controlled Trials (July 2001 through January 2011) were searched for reports from randomized, controlled trials with no language restriction.
Authors screened abstracts to identify reports from trials comparing blood pressure targets in adults with CKD that had more than 50 participants per group; at least 1-year follow-up; and outcomes of death, kidney failure, cardiovascular events, change in kidney function, number of antihypertensive agents, and adverse events.
Reviewers extracted data on study design, methods, sample characteristics, interventions, comparators, outcomes, number of medications, and adverse events and rated study quality and quality of analyses for proteinuria subgroups.
Three trials with a total of 2272 participants were included. Overall, trials did not show that a blood pressure target of less than 125/75 to 130/80 mm Hg is more beneficial than a target of less than 140/90 mm Hg. Lower-quality evidence suggests that a low target may be beneficial in subgroups with proteinuria greater than 300 to 1000 mg/d. Participants in the low target groups needed more antihypertensive medications and had a slightly higher rate of adverse events.
No study included patients with diabetes. Trial duration may have been too short to detect differences in clinically important outcomes, such as death and kidney failure. Ascertainment and reporting of adverse events was not uniform.
Available evidence is inconclusive but does not prove that a blood pressure target of less than 130/80 mm Hg improves clinical outcomes more than a target of less than 140/90 mm Hg in adults with CKD. Whether a lower target benefits patients with proteinuria greater than 300 to 1000 mg/d requires further study.
慢性肾脏病（CKD）患者的最佳血压目标值尚不明确。
总结比较成人 CKD 患者较低与较高血压目标值的试验，并重点关注蛋白尿作为一个效应修饰因素。
检索 MEDLINE 和 Cochrane 对照试验中心注册库（2001 年 7 月至 2011 年 1 月），无语言限制，查找比较 CKD 成人血压目标值的随机对照试验报告。
作者筛选摘要，以确定来自比较 CKD 成人血压目标值的试验报告，每组至少有 50 名参与者；至少有 1 年的随访；以及死亡、肾衰竭、心血管事件、肾功能变化、降压药物数量和不良事件的结局。
评价者提取了研究设计、方法、样本特征、干预措施、比较、结局、药物数量和不良事件的数据，并对研究质量和蛋白尿亚组分析质量进行了评价。
纳入 3 项共 2272 名参与者的试验。总体而言，这些试验并未表明血压目标值＜125/75 至 130/80mmHg 比＜140/90mmHg 更有益。低质量证据表明，在蛋白尿大于 300 至 1000mg/d 的亚组中，低目标可能有益。低目标组的参与者需要更多的降压药物，且不良事件发生率略高。
没有研究纳入糖尿病患者。试验持续时间可能太短，无法检测到死亡和肾衰竭等临床重要结局的差异。不良事件的确定和报告并不统一。
现有证据尚无定论，但不能证明 CKD 成人血压目标值＜130/80mmHg 比＜140/90mmHg 能更改善临床结局。蛋白尿大于 300 至 1000mg/d 的患者更低的目标值是否有益，尚需进一步研究。
