University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Mayo Clinic, Division of Nephrology and Hypertension, 200 First Street Southwest, Rochester, MN 55905, USA.
Nat Rev Nephrol. 2015 Sep;11(9):555-63. doi: 10.1038/nrneph.2015.114. Epub 2015 Jul 28.
Hypertension is a common comorbidity in patients with impaired kidney function. The kidney exerts a marked degree of control over blood pressure through various mechanisms, such as by regulating sodium balance and hormone secretion through the activity of the renin-angiotensin system. The kidney is susceptible to injury, and if already damaged can be at risk of further loss of function as a consequence of elevated blood pressure. Once elevated blood pressure is identified, a combination of sensible lifestyle measures, such as sodium restriction and weight loss, with pharmacological intervention to reduce blood pressure will usually achieve blood pressure goals. In this Review, we outline the importance of blood pressure control for patients with chronic kidney disease (CKD), the mechanisms that affect blood pressure control, and the basis for non-drug and drug therapies. We further discuss the rationale for <140 mmHg systolic and <90 mmHg diastolic targets for blood pressure in patients with CKD, with consideration for tighter targets in the setting of proteinuria.
高血压是肾功能受损患者常见的合并症。肾脏通过多种机制对血压进行显著控制，例如通过肾素-血管紧张素系统的活性调节钠平衡和激素分泌。肾脏容易受到损伤，如果已经受损，可能会因血压升高而进一步丧失功能。一旦发现血压升高，通常可以通过合理的生活方式措施（如限制钠摄入和减轻体重）与药物干预相结合来降低血压，以达到降压目标。在本综述中，我们概述了血压控制对慢性肾脏病（CKD）患者的重要性、影响血压控制的机制以及非药物和药物治疗的基础。我们进一步讨论了 CKD 患者收缩压<140 mmHg 和舒张压<90 mmHg 目标血压的合理性，同时考虑了蛋白尿情况下更严格的目标血压。
