Tamura Kouichi, Kanaoka Tomohiko, Ohsawa Masato, Haku Sona, Azushima Kengo, Maeda Akinobu, Dejima Toru, Wakui Hiromichi, Ozawa Motoko, Shigenaga Atsu-Ichiro, Toya Yoshiyuki, Umemura Satoshi
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine Yokohama, Japan.
Am J Cardiovasc Dis. 2011;1(3):236-43. Epub 2011 Sep 8.
Presently hypertensive patients with chronic kidney disease (CKD) particularly diabetic nephropathy are increasing in number, and cardiovascular and renal complications are the most common cause of death in these patients. The control of blood pressure (BP) is an important issue in cardiovascular and renal protection in hypertensive patients with CKD. Although hypertension is usually diagnosed based on measurements of BP recorded during a visit to a physician, that is, office BP, several studies have shown that target organ damage and prognosis are more closely associated with ambulatory BP than with office BP. It should be important to achieve the target absolute BP levels in hypertensive patients obtained either by office or home measurements or by ambulatory recordings for the cardiovascular and renal protection. Noninvasive techniques for measuring ambulatory BP have allowed BP to be monitored during both day and night. Additionally, ambulatory BP monitoring can provide information on circadian BP variation and short-term BP variability, which is suggested to be associated with cardiovascular and renal morbidity and mortality. This review will briefly summarize the emerging concept of anti-hypertensive therapy based on ambulatory BP profile in hypertensive patients with CKD.
目前，患有慢性肾脏病（CKD）尤其是糖尿病肾病的高血压患者数量正在增加，心血管和肾脏并发症是这些患者最常见的死亡原因。在患有CKD的高血压患者中，控制血压（BP）是心血管和肾脏保护方面的一个重要问题。虽然高血压通常是根据在看医生时记录的血压测量值（即诊室血压）来诊断的，但多项研究表明，靶器官损害和预后与动态血压的关联比与诊室血压更为密切。对于心血管和肾脏保护而言，无论是通过诊室测量、家庭测量还是动态记录获得的高血压患者，达到目标绝对血压水平都很重要。测量动态血压的非侵入性技术使血压能够在白天和夜间都得到监测。此外，动态血压监测可以提供有关昼夜血压变化和短期血压变异性的信息，这被认为与心血管和肾脏发病率及死亡率相关。本综述将简要总结基于CKD高血压患者动态血压谱的抗高血压治疗的新观念。
