Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Curr Opin Cardiol. 2013 Jul;28(4):439-45. doi: 10.1097/HCO.0b013e32836208c2.
Persons with chronic kidney disease (CKD) exhibit a disproportionate burden of elevated blood pressure (BP) with a high prevalence of premature end-stage renal disease and cardiovascular events.
Results of recent randomized controlled clinical trials suggest that most patients with reduced estimated glomerular filtration rate (eGFR) and hypertension experience optimal clinical outcomes when SBP is less than 140 mmHg and DBP is less than 90 mmHg. The benefit of additional lowering of SBP to less than 130 mmHg and DBP to less than 80 mmHg remains controversial, and appears to be of most benefit to the subset of CKD patients with proteinuria (>300 mg/day). The combination of a diuretic and an angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEI) has demonstrated particular promise in patients with reduced eGFR and proteinuria.
A practical approach in clinical practice for the treatment of elevated BP in persons with CKD is to achieve a BP less than 140/90 mmHg with a combination of diuretic and an ARB or ACEI. Consideration for a lower BP goal and other therapeutic and nontherapeutic interventions can be made based on the cause of CKD, presence of proteinuria, or other coexisting medical conditions.
慢性肾脏病（CKD）患者的血压升高负担不成比例，终末期肾病和心血管事件的发生率较高。
最近随机对照临床试验的结果表明，大多数估算肾小球滤过率（eGFR）降低和高血压患者的血压在收缩压（SBP）<140mmHg 和舒张压（DBP）<90mmHg 时可获得最佳临床结果。将 SBP 进一步降低至<130mmHg 和 DBP 降低至<80mmHg 的获益仍存在争议，并且似乎对蛋白尿（>300mg/天）较多的 CKD 患者亚组最有益。利尿剂联合血管紧张素受体阻滞剂（ARB）或血管紧张素转换酶抑制剂（ACEI）在降低 eGFR 和蛋白尿的患者中显示出特别的前景。
在 CKD 患者中治疗血压升高的临床实践中，实用的方法是使用利尿剂联合 ARB 或 ACEI 将血压控制在<140/90mmHg 以下。可以根据 CKD 的病因、蛋白尿的存在或其他并存的医疗状况，考虑更低的血压目标以及其他治疗和非治疗干预措施。
