Gosmanova Elvira O, Kovesdy Csaba P
Nephrology Division, Department of Medicine, Albany Medical College, Albany, NY, USA.
Nephrology Section, Stratton VA Medical Center, Albany, NY, USA.
Curr Cardiol Rep. 2016 Sep;18(9):88. doi: 10.1007/s11886-016-0769-y.
Hypertension management is one of the most common clinical tasks in the care of patients with chronic kidney disease (CKD). Elevated blood pressure (BP) is associated with greater risk of all-cause mortality, cardiovascular (CV) disease, and CKD progression in this population. However, it is still debated, to what target(s) BP should be lowered in patients with signs of kidney damage. The Systolic Blood Pressure Intervention Trial (SPRINT) provided new and important information about the effects of lowering systolic BP to a target of <120 mmHg, which is lower than the levels currently recommended by the most guidelines (<140/90 mmHg). The SPRINT results were not only exciting but also surprising for many clinicians because evidence from well-conducted observational studies in CKD patient showed increased mortality in patients with CKD whose office systolic BP levels were <120 mmHg, as compared with systolic BP in 120-139 mmHg range. In the present review, we will discuss whether a systolic BP goal of <120 mmHg that was found to be beneficial for CV and all-cause mortality outcomes in the SPRINT can be generalized to the entire CKD population.
高血压管理是慢性肾脏病（CKD）患者护理中最常见的临床任务之一。在这一人群中，血压（BP）升高与全因死亡率、心血管（CV）疾病及CKD进展风险增加相关。然而，对于有肾脏损害迹象的患者，血压应降至何种目标仍存在争议。收缩压干预试验（SPRINT）提供了关于将收缩压降至<120 mmHg目标的效果的新的重要信息，这一目标低于目前大多数指南所推荐的水平（<140/90 mmHg）。SPRINT的结果不仅令人兴奋，对许多临床医生来说也很意外，因为在CKD患者中进行的精心设计的观察性研究的证据显示，与收缩压在120 - 139 mmHg范围内的患者相比，诊室收缩压水平<120 mmHg的CKD患者死亡率增加。在本综述中，我们将讨论SPRINT中发现的对CV和全因死亡率结局有益的收缩压目标<120 mmHg是否可以推广到整个CKD人群。
