Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland.
Hypertension Research Foundation, Saint-Légier, Switzerland.
Vasc Health Risk Manag. 2021 Jan 6;17:1-11. doi: 10.2147/VHRM.S292522. eCollection 2021.
In the general population, the prevalence of moderate and severe chronic kidney disease (CKD) is usually below 5% but this figure is often higher in specific groups of patients such as those with type 2 diabetes. Patients with advanced CKD (CKD stage 3b and 4) are at high or very high cardiovascular risk, and their risk of progressing towards end-stage kidney disease (CKD stage 5) and the need of renal replacement therapy are elevated. Hypertension is a major cause of poor cardiovascular and renal outcomes in severe CKD. Therefore, an adequate control of blood pressure (BP) is mandatory. However, normalizing BP is often challenging in these patients because the clinical management of hypertension in advanced CKD is not well defined and rarely supported by large randomized controlled trials. In the present review, we discuss the characteristics of hypertension in advanced CKD, excluding dialysis, and its management integrating data from recent clinical studies and a pragmatic approach enriched by a long-standing clinical experience.
在一般人群中，中度和重度慢性肾脏病（CKD）的患病率通常低于 5%，但在某些特定患者群体中，如 2 型糖尿病患者，这一数字往往更高。晚期 CKD（CKD 3b 期和 4 期）患者心血管风险较高或极高，他们向终末期肾脏病（CKD 5 期）进展的风险以及需要肾脏替代治疗的风险增加。高血压是严重 CKD 患者心血管和肾脏预后不良的主要原因。因此，必须对血压（BP）进行充分控制。然而，在这些患者中，使血压正常化通常具有挑战性，因为在晚期 CKD 中，高血压的临床管理尚未明确界定，很少有大型随机对照试验支持。在本次综述中，我们讨论了晚期 CKD 中高血压的特征，不包括透析，并结合最近的临床研究数据以及长期临床经验丰富的实用方法来讨论其管理。
