Der Mesropian Paul J, Shaikh Gulvahid, Cordero Torres Emmanuelle, Bilal Anum, Mathew Roy O
Division of Nephrology, Department of Medicine, Albany Stratton VA Medical Center, Albany, NY, USA.
Division of Nephrology, Department of Medicine, Albany Stratton VA Medical Center, Albany, NY, USA.
J Am Soc Hypertens. 2018 Mar;12(3):154-181. doi: 10.1016/j.jash.2018.01.005. Epub 2018 Jan 31.
Hypertension is an important contributor to progression of nondiabetic chronic kidney disease (CKD). Compelling observational evidence indicates that the divergence of blood pressure (BP) away from an ideal range in either direction is associated with a progressive rise in the risk of mortality and cardiovascular and renal disease progression. To date, various clinical trials and meta-analyses examining strict versus less intensive BP control in nondiabetic CKD have not conclusively demonstrated a renal advantage of one BP-lowering approach over another, except in certain subgroups such as proteinuric patients where evidence is circumstantial. As recent data have come to light suggesting that intensive BP control yields superior survival and cardiovascular outcomes in patients at high risk for cardiovascular disease, interest in the prospect of whether such benefit extends to individuals with CKD has surged. This review is a comprehensive analysis of antihypertensive literature in nondiabetic renal disease, with a particular emphasis on BP target.
高血压是导致非糖尿病慢性肾脏病（CKD）进展的重要因素。有力的观察证据表明，血压（BP）偏离理想范围的任何一个方向均与死亡率、心血管疾病和肾脏疾病进展风险的逐步上升相关。迄今为止，各种临床试验和荟萃分析对非糖尿病CKD患者进行严格与较宽松血压控制的比较，除了在某些亚组（如蛋白尿患者，证据并不确凿）外，尚未最终证明一种降压方法相对于另一种方法具有肾脏方面的优势。由于最近有数据表明，强化血压控制可使心血管疾病高危患者获得更好的生存率和心血管结局，因此人们对这种益处是否也适用于CKD患者的前景兴趣大增。本综述是对非糖尿病肾病抗高血压文献的全面分析，特别强调了血压目标。
