Sinha Arjun D, Agarwal Rajiv
Division of Nephrology, Indianapolis, IN ; Richard L. Roudebush VA Medical Center, Indianapolis, IN.
Curr Cardiovasc Risk Rep. 2014 Oct;8(10). doi: 10.1007/s12170-014-0400-y.
Chronic kidney disease is common and frequently complicated with hypertension. As a major modifiable risk factor for cardiovascular disease in this high risk population, treatment of hypertension in chronic kidney disease is of paramount importance. We review the epidemiology and pathogenesis of hypertension in chronic kidney disease and then update the latest study results for treatment including salt restriction, invasive endovascular procedures, and pharmacologic therapy. Recent trials draw into question the efficacy of renal artery stenting or renal denervation for hypertension in chronic kidney disease, as well as renin-angiotensin-aldosterone system blockade as first line therapy of hypertension in end stage renal disease. Positive trial results reemphasize salt restriction and challenge the prevailing prejudice against the use of thiazide-like diuretics in advanced chronic kidney disease. Lastly, clinical practice guidelines are trending away from recommending tight blood pressure control in chronic kidney disease.
慢性肾脏病很常见，且常并发高血压。作为这一高危人群心血管疾病的主要可改变危险因素，慢性肾脏病患者的高血压治疗至关重要。我们回顾了慢性肾脏病高血压的流行病学和发病机制，然后更新了包括限盐、侵入性血管内手术和药物治疗在内的最新治疗研究结果。近期试验对肾动脉支架置入术或肾去神经术治疗慢性肾脏病高血压的疗效提出质疑，同时也对肾素 - 血管紧张素 - 醛固酮系统阻断作为终末期肾病高血压一线治疗方法提出质疑。阳性试验结果再次强调限盐，并挑战了对晚期慢性肾脏病使用噻嗪类利尿剂的普遍偏见。最后，临床实践指南正逐渐不再推荐在慢性肾脏病中进行严格的血压控制。
