Ospedale Policlinico San Martino, Università degli Studi and I.R.C.C.S, Genoa, Italy.
Clinica Medica, Dipartimento di Medicina e Chirurgia, Università Milano-Bicocca, Milano, Italy.
J Clin Hypertens (Greenwich). 2018 Nov;20(11):1560-1574. doi: 10.1111/jch.13396. Epub 2018 Sep 28.
A bidirectional relationship between hypertension and kidney disease, with one exacerbating the effect of the other, is well established. Elevated blood pressure (BP) is a well-recognized, modifiable risk factor for cardiovascular (CV) disease as well as for development and progression of chronic kidney disease and, therefore, the identification of optimal BP target is a key issue in the management of renal patients. Recent large trials and real life cohort studies have indicated that below a definite BP value renal protection seems to plateau and too low levels may even be associated with a paradoxical increase in renal morbidity, thus reviving the debate about the so called BP -renal function J-curve relationship. Existing evidence supports a systolic target around 130 mm Hg to combine both renal and CV protection and possibly lower levels in the presence of overt proteinuria.
高血压和肾病之间存在双向关系，一方会加重另一方的病情，这一点已得到充分证实。高血压是心血管疾病以及慢性肾脏病发生和进展的公认可改变的危险因素，因此，确定最佳血压目标是肾脏患者管理的关键问题。最近的大型试验和真实队列研究表明，血压值低于一定水平后，肾脏保护似乎趋于平稳，而血压值过低甚至可能与肾脏发病率的反常增加相关，从而重新引发了关于所谓的血压-肾功能 J 型曲线关系的争论。现有证据支持将收缩压目标设定在 130mmHg 左右，以同时实现肾脏和心血管保护，而在明显蛋白尿的情况下可能需要更低的血压水平。
