Escobar Carlos, Echarri Rocio, Barrios Vivencio
Department of Cardiology, Hospital Infanta Sofía, Madrid, Spain.
Int J Nephrol Renovasc Dis. 2012;5:69-80. doi: 10.2147/IJNRD.S7048. Epub 2012 Apr 3.
Hypertension and renal disease are closely related. In fact, there is an inverse linear relationship between renal function and prevalence of hypertension. Hypertensive patients with renal dysfunction exhibit a poor clinical profile, which markedly increases their risk for cardiovascular outcomes. This review considers the available evidence on the best therapeutic approach for optimizing renovascular protection in the hypertensive population. To effectively reduce or at least slow the establishment and progression of renal disease in the hypertensive population it is critical to reach blood pressure targets. Many studies have shown that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prevent or at least delay the development of microalbuminuria in patients with hypertension and type 2 diabetes, reduce the incidence of overt diabetic nephropathy, and are also beneficial in patients with nondiabetic renal disease. Therefore, renin-angiotensin system (RAS) inhibition plays a key role in the prevention of renal outcomes. As the majority of patients with hypertension will need at least two antihypertensive agents to achieve blood pressure goals, the use of RAS inhibitors is a mandatory part of antihypertensive therapy. The question of which antihypertensive agent is the best choice for combining with RAS blockers should be considered. Many studies have shown that diuretics and calcium channel blockers are the best choice. However, more studies are needed to clarify the subgroups of patients who will benefit more from a combination with a diuretic or from a combination with a calcium channel blocker. To date, RAS inhibitors recommended in this context are angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Aliskiren, the first oral direct renin inhibitor available, has shown promising results.
高血压与肾脏疾病密切相关。事实上，肾功能与高血压患病率之间存在负线性关系。肾功能不全的高血压患者临床情况较差，这显著增加了他们发生心血管疾病的风险。本综述探讨了关于在高血压人群中优化肾血管保护的最佳治疗方法的现有证据。为了有效降低或至少减缓高血压人群中肾脏疾病的发生和进展，达到血压目标至关重要。许多研究表明，血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂可预防或至少延缓高血压合并2型糖尿病患者微量白蛋白尿的发生，降低显性糖尿病肾病的发生率，对非糖尿病肾病患者也有益处。因此，肾素-血管紧张素系统（RAS）抑制在预防肾脏疾病转归中起关键作用。由于大多数高血压患者需要至少两种降压药物才能实现血压目标，使用RAS抑制剂是降压治疗的必要组成部分。应考虑哪种降压药物是与RAS阻滞剂联合使用的最佳选择这一问题。许多研究表明，利尿剂和钙通道阻滞剂是最佳选择。然而，需要更多研究来明确哪些亚组患者从与利尿剂联合或与钙通道阻滞剂联合中获益更多。迄今为止，在此背景下推荐的RAS抑制剂是血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂。阿利吉仑，首个可用的口服直接肾素抑制剂，已显示出有前景的结果。
