Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
Am J Hypertens. 2012 Mar;25(3):342-7. doi: 10.1038/ajh.2011.217. Epub 2011 Nov 17.
Hypertension is a key risk factor for adverse renal outcomes in chronic kidney disease (CKD), and strict blood pressure control is recommended to halt its progression. This study assessed blood pressure control in the Japanese CKD population.
We used a nationwide database of 250,130 subjects (aged 20-88), including 45,845 CKD subjects (18.3%), participated in an annual health check, "The Specific Health Check and Guidance in Japan," and examined the relationship between CKD status and blood pressure. Blood pressures were measured in sitting position by trained staff, and target blood pressure for CKD subjects was defined as systolic (SBP)/diastolic blood pressure (DBP) <130/80 mm Hg.
In total population, CKD subjects had a higher prevalence of hypertension (58.0% vs. 41.8%, P < 0.001) and a higher proportion with antihypertensive medication (42.4% vs. 26.7%, P < 0.001), compared with non-CKD subjects. The proportion of subjects achieving target blood pressure was significantly lower among total CKD subjects than among total non-CKD subjects (34.6% vs. 43.8%, P ≤ 0.001). Among CKD subjects, these proportions were especially low in those with stage 4-5 (24.3-27.5%), those on antihypertensive medication (21.6%) and those with proteinuria ≥2± (21.3%). Logistic regression analysis showed that independent factors for high-blood pressure in CKD subjects were age, male gender, alcohol consumption, nonsmoking, diabetes, dyslipidemia, obesity, proteinuria, and antihypertensive medication.
Blood pressure control was inadequate in the majority of Japanese CKD subjects, despite antihypertensive treatment. More aggressive efforts to achieve target blood pressures among CKD subjects are recommended.
高血压是慢性肾脏病（CKD）不良肾脏结局的一个关键危险因素，建议严格控制血压以阻止其进展。本研究评估了日本 CKD 人群的血压控制情况。
我们使用了一个包含 250130 名受试者（年龄 20-88 岁）的全国性数据库，其中包括 45845 名 CKD 受试者（18.3%），他们参加了年度健康检查“日本特定健康检查和指导”，并检查了 CKD 状态与血压之间的关系。血压由经过培训的工作人员在坐姿下测量，CKD 受试者的目标血压定义为收缩压（SBP）/舒张压（DBP）<130/80mmHg。
在总人群中，与非 CKD 受试者相比，CKD 受试者高血压的患病率更高（58.0% vs. 41.8%，P<0.001），服用降压药物的比例也更高（42.4% vs. 26.7%，P<0.001）。与非 CKD 受试者相比，总 CKD 受试者中达到目标血压的患者比例明显更低（34.6% vs. 43.8%，P≤0.001）。在 CKD 受试者中，这些比例在 4-5 期（24.3-27.5%）、服用降压药物（21.6%）和蛋白尿≥2+（21.3%）的患者中尤其低。Logistic 回归分析显示，CKD 患者高血压的独立因素是年龄、男性、饮酒、不吸烟、糖尿病、血脂异常、肥胖、蛋白尿和服用降压药物。
尽管进行了降压治疗，但大多数日本 CKD 患者的血压控制仍不理想。建议对 CKD 患者更积极地努力实现目标血压。
