Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC.
Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC.
Adv Chronic Kidney Dis. 2019 Mar;26(2):131-136. doi: 10.1053/j.ackd.2019.01.003.
Essential hypertension is a clinical diagnosis based on the presence of an elevated systemic blood pressure on physical examination without a clear inciting cause. It has multiple etiologies and is not a homogeneous disorder. Hypertension contributes to the development and progression of atherosclerotic cardiovascular diseases, and antihypertensive treatment reduces the risk of fatal and nonfatal myocardial infarction, stroke, and congestive heart failure. Although hypertension is frequently present in nondiabetic individuals with low levels of proteinuria and chronic kidney disease, reducing blood pressures in this population does not reliably slow nephropathy progression. Many of these patients with recent African ancestry have the primary kidney disease "solidified glomerulosclerosis" that is strongly associated with renal-risk variants in the apolipoprotein L1 gene (APOL1). This kidney disease contributes to secondarily elevated blood pressures. The APOL1-associated spectrum of nondiabetic nephropathy also includes proteinuric kidney diseases, idiopathic focal segmental glomerulosclerosis, collapsing glomerulopathy, severe lupus nephritis, and sickle cell nephropathy. This article reviews relationships between mild to moderate essential hypertension and chronic kidney disease with a focus on the role of APOL1 in development of hypertension. Available evidence strongly supports that APOL1 renal-risk variants associate with glomerulosclerosis in African Americans, which then causes secondary hypertension, not with essential hypertension per se.
原发性高血压是一种临床诊断，基于体检时存在系统性血压升高而无明确的激发原因。它有多种病因，不是一种均质的疾病。高血压可导致动脉粥样硬化性心血管疾病的发生和进展，降压治疗可降低致命性和非致命性心肌梗死、中风和充血性心力衰竭的风险。虽然原发性高血压在蛋白尿和慢性肾脏病水平较低的非糖尿病个体中很常见，但降低这部分人群的血压并不能可靠地减缓肾脏病进展。许多新近具有非洲血统的此类患者存在原发性肾脏病“肾小球硬化症”，该疾病与载脂蛋白 L1 基因（APOL1）中的肾脏风险变异密切相关。这种肾脏病导致血压继发性升高。APOL1 相关的非糖尿病性肾脏病谱还包括蛋白尿性肾脏病、特发性局灶节段性肾小球硬化症、塌陷性肾小球病、严重狼疮性肾炎和镰状细胞性肾脏病。本文综述了轻度至中度原发性高血压与慢性肾脏病之间的关系，重点关注 APOL1 在高血压发展中的作用。现有证据强烈支持，APOL1 肾脏风险变异与非裔美国人的肾小球硬化症相关，进而导致继发性高血压，而不是原发性高血压本身。
