St. John Providence Health System, Providence Hospital and Medical Center, High-Risk Hypertension Program, Providence Heart Institute, Southfield, MI, USA.
Curr Cardiol Rep. 2011 Dec;13(6):492-501. doi: 10.1007/s11886-011-0215-0.
Hypertension and chronic kidney disease (CKD) are public health problems well known to the national and international medical communities. Blood pressure (BP) control in patients with CKD stage III and IV plays a key factor in reducing cardiovascular risk and renal disease progression. We conducted a literature review of recent studies addressing BP targets and cardiorenal outcomes in patients with CKD. Multiple studies demonstrated cardiovascular benefits associated with greater BP reduction. Nevertheless, a U-shaped relationship between BP, cardiovascular events, and renal function was present. In patients with CKD stage III and IV, a BP less than 140/90 mm Hg appeared to be a reasonable target. Moreover, in patients with CKD and proteinuria of more than 1 g/day, a target systolic BP of 120 to 130 mm Hg and diastolic BP of 70 to 80 mm Hg yielded the greatest benefit while avoiding most of the adverse cardiovascular outcomes associated with lower levels of BP.
高血压和慢性肾脏病（CKD）是国内外医学界熟知的公共卫生问题。CKD 第三和第四阶段患者的血压（BP）控制对于降低心血管风险和肾脏疾病进展起着关键作用。我们对近期研究进行了文献综述，这些研究探讨了 CKD 患者的 BP 目标和心肾结局。多项研究表明，BP 降低与心血管益处相关。然而，BP、心血管事件和肾功能之间存在 U 型关系。在 CKD 第三和第四阶段患者中，BP 低于 140/90 mmHg 似乎是一个合理的目标。此外，对于 CKD 合并蛋白尿超过 1g/天的患者，目标收缩压为 120-130mmHg，舒张压为 70-80mmHg，可带来最大获益，同时避免与较低 BP 水平相关的大多数不良心血管结局。
