Department of Nephrology, University Hospital of Ioannina, 455 00, Ioannina, Greece.
Department of Internal Medicine, Medical School, University of Ioannina, 451 10, Ioannina, Greece.
Curr Hypertens Rep. 2018 Jun 11;20(8):64. doi: 10.1007/s11906-018-0864-0.
Chronic kidney disease (CKD) is recognized as a worldwide epidemic. Hypertension commonly coexists with CKD and its prevalence is progressively increasing as kidney function declines.
For patients with established CKD and/or diabetes with albuminuria, the updated hypertension guidelines have recommended a blood pressure (BP) goal < 130/80 mmHg. Blood pressure level above 130/80 mmHg in CKD patients requires lifestyle modifications and multiple antihypertensive medications. According to recent guidelines, angiotensin-converting enzyme (ACE) inhibitors should be the drugs of first choice. Angiotensin II receptor blockers (ARBs) should be used if the ACE inhibitor is not tolerated. Non-dihydropyridine CCBs consistently reduce albuminuria and slow the decline in kidney function. Dihydropyridine CCBs should not be used as monotherapy in proteinuric CKD patients but always in combination with a RAAS blocker. Diuretics are commonly used and represent the cornerstone in the management of CKD patients. All the other agents are used when treatment with the other primary agents have failed. In patients with CKD, an intensive BP goal < 130/80 mmHg has been recommended. We review current treatment options.
慢性肾脏病（CKD）是一种全球性的流行疾病。高血压常与 CKD 并存，随着肾功能下降，其患病率逐渐增加。
对于已确诊 CKD 和/或伴有蛋白尿的糖尿病患者，最新的高血压指南建议血压（BP）目标<130/80mmHg。CKD 患者血压>130/80mmHg 需要生活方式改变和多种降压药物。根据最新指南，血管紧张素转换酶（ACE）抑制剂应作为首选药物。如果不能耐受 ACE 抑制剂，则应使用血管紧张素 II 受体阻滞剂（ARB）。非二氢吡啶类钙通道阻滞剂（CCB）可持续降低蛋白尿并减缓肾功能下降。二氢吡啶类 CCB 不应单独用于蛋白尿性 CKD 患者，而应始终与 RAAS 阻滞剂联合使用。利尿剂通常被使用，是 CKD 患者治疗的基石。当其他主要药物治疗失败时，会使用所有其他药物。在 CKD 患者中，建议将血压目标降至<130/80mmHg。我们回顾了当前的治疗选择。
