Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany.
Curr Opin Nephrol Hypertens. 2014 Mar;23(2):180-5. doi: 10.1097/01.mnh.0000441050.36783.ba.
To summarize the available evidence on whether a lower blood pressure (BP) treatment target can ameliorate the progression of nondiabetic chronic kidney disease (CKD), and prevent cardiovascular events in CKD patients.
The three prospective, randomized controlled trials which addressed the question of progression of CKD suggest that a lower BP treatment goal (<130/80 mmHg) may lead to better preservation of renal function, but only in those patients with proteinuria of more than 300 mg/day. However, the evidence is not conclusive. We are not aware of adequately powered, randomized trials that have assessed the efficacy of lower target BP levels for the prevention of cardiovascular events specifically in nondiabetic CKD patients. The available circumstantial evidence (e.g., subgroup analyses of CKD patients in cardiovascular trials) fails to reveal a clear benefit of a lower BP goal.
There is currently no convincing evidence to recommend a lower than standard BP treatment target of less than 140/90 mmHg for all patients with nondiabetic CKD. A lower treatment target of less than 130/80 mmHg may delay renal disease progression but only in patients with proteinuria.
探讨更低的血压（BP）治疗目标是否可以改善非糖尿病慢性肾脏病（CKD）的进展，以及预防 CKD 患者的心血管事件。
三项前瞻性、随机对照试验解决了 CKD 进展的问题，表明更低的 BP 治疗目标（<130/80mmHg）可能会更好地保护肾功能，但仅适用于蛋白尿超过 300mg/天的患者。然而，证据并不确凿。我们不知道是否有足够效力的、随机试验评估了更低的目标 BP 水平对非糖尿病 CKD 患者心血管事件预防的效果。现有的间接证据（例如，心血管试验中 CKD 患者的亚组分析）未能显示出更低的 BP 目标有明确的益处。
目前，没有令人信服的证据推荐将非糖尿病 CKD 患者的标准 BP 治疗目标值设定为<140/90mmHg 以下。更低的治疗目标值<130/80mmHg 可能会延迟肾脏疾病的进展，但仅适用于蛋白尿患者。
