Tsai Wan-Chuan, Wu Hon-Yen, Peng Yu-Sen, Yang Ju-Yeh, Chen Hung-Yuan, Chiu Yen-Ling, Hsu Shih-Ping, Ko Mei-Ju, Pai Mei-Fen, Tu Yu-Kang, Hung Kuan-Yu, Chien Kuo-Liong
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan3Department of Marketing and Distribution Management, Oriental Institute of Technology, New Taipei City, Taiwan.
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan5School of Medicine, National Yang-Ming University, Taipei, Taiwan.
JAMA Intern Med. 2017 Jun 1;177(6):792-799. doi: 10.1001/jamainternmed.2017.0197.
The optimal blood pressure (BP) target remains debated in nondiabetic patients with chronic kidney disease (CKD).
To compare intensive BP control (<130/80 mm Hg) with standard BP control (<140/90 mm Hg) on major renal outcomes in patients with CKD without diabetes.
Searches of PubMed, MEDLINE, Embase, and Cochrane Library for publications up to March 24, 2016.
Randomized clinical trials that compared an intensive vs a standard BP target in nondiabetic adults with CKD, reporting changes in glomerular filtration rate (GFR), doubling of serum creatinine level, 50% reduction in GFR, end-stage renal disease (ESRD), or all-cause mortality.
Random-effects meta-analyses for pooling effect measures. Meta-regression and subgroup analyses for exploring heterogeneity.
Differences in annual rate of change in GFR were expressed as mean differences with 95% CIs. Differences in doubling of serum creatinine or 50% reduction in GFR, ESRD, composite renal outcome, and all-cause mortality were expressed as risk ratios (RRs) with 95% CIs.
We identified 9 trials with 8127 patients and a median follow-up of 3.3 years. Compared with standard BP control, intensive BP control did not show a significant difference on the annual rate of change in GFR (mean difference, 0.07; 95% CI, -0.16 to 0.29 mL/min/1.73 m2/y), doubling of serum creatinine level or 50% reduction in GFR (RR, 0.99; 95% CI, 0.76-1.29), ESRD (RR, 0.96; 95% CI, 0.78-1.18), composite renal outcome (RR, 0.99; 95% CI, 0.81-1.21), or all-cause mortality (RR, 0.95; 95% CI, 0.66-1.37). Nonblacks and patients with higher levels of proteinuria showed a trend of lower risk of kidney disease progression with intensive BP control.
Targeting BP below the current standard did not provide additional benefit for renal outcomes compared with standard treatment during a follow-up of 3.3 years in patients with CKD without diabetes. However, nonblack patients or those with higher levels of proteinuria might benefit from the intensive BP-lowering treatments.
在非糖尿病慢性肾脏病（CKD）患者中，最佳血压（BP）目标仍存在争议。
比较强化血压控制（<130/80 mmHg）与标准血压控制（<140/90 mmHg）对非糖尿病CKD患者主要肾脏结局的影响。
检索PubMed、MEDLINE、Embase和Cochrane图书馆截至2016年3月24日的出版物。
比较非糖尿病成年CKD患者强化与标准血压目标的随机临床试验，报告肾小球滤过率（GFR）变化、血清肌酐水平翻倍、GFR降低50%、终末期肾病（ESRD）或全因死亡率。
采用随机效应荟萃分析汇总效应量。采用Meta回归和亚组分析探索异质性。
GFR年变化率差异以95%CI的均值差异表示。血清肌酐翻倍或GFR降低50%、ESRD、复合肾脏结局和全因死亡率差异以95%CI的风险比（RR）表示。
我们纳入了9项试验，共8127例患者，中位随访时间为3.3年。与标准血压控制相比，强化血压控制在GFR年变化率（均值差异为0.07；95%CI为-0.16至0.29 mL/min/1.73 m²/年）、血清肌酐水平翻倍或GFR降低50%（RR为0.99；95%CI为0.76-1.29）、ESRD（RR为0.96；95%CI为0.78-1.18）、复合肾脏结局（RR为0.99；95%CI为0.81-1.21）或全因死亡率（RR为0.95；95%CI为0.66-1.37）方面未显示出显著差异。非黑人患者和蛋白尿水平较高的患者强化血压控制有降低肾病进展风险的趋势。
在非糖尿病CKD患者3.3年的随访中，与标准治疗相比，将血压控制在当前标准以下对肾脏结局无额外益处。然而，非黑人患者或蛋白尿水平较高的患者可能从强化降压治疗中获益。
