Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Kidney Int. 2021 Mar;99(3):686-695. doi: 10.1016/j.kint.2020.12.019.
The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease (CKD) recommends a target systolic blood pressure under 120 mmHg based on standardized office blood pressure measurement. Here, we examined the potential implications of this new guideline for blood pressure lowering with antihypertensive medication among adults in the United States with CKD compared to the 2012 KDIGO guideline (target blood pressure 130/80 mmHg or under with albuminuria or 140/90 mmHg or under without albuminuria) and the 2017 American College of Cardiology/American Heart Association (target blood pressure under 130/80 mmHg) guideline. Additionally, we determined implications of the 2021 KDIGO guideline for angiotensin converting enzyme inhibitor (ACEi) or angiotensin II-receptor blocker (ARB) use for those with albuminuria (recommended at systolic blood pressure of 120 mmHg or over) compared to the 2012 KDIGO guideline (recommended at blood pressures over 130/80 mmHg). Data were analyzed from 1,699 adults with CKD (estimated glomerular filtration rate 15-59 ml/min/1.73m or a urinary albumin-to-creatinine ratio of 30 mg/g or more) in the 2015-2018 National Health and Nutrition Examination Survey and averaged up to three standardized blood pressure measurements. Among adults with CKD, 69.5% were eligible for blood pressure lowering according to the 2021 KDIGO guideline, compared with 49.8% as per 2012 KDIGO or 55.6% as per 2017 American College of Cardiology/American Heart Association guidelines. Among those with albuminuria, 78.2% were eligible for ACEi/ARB use by the 2021 KDIGO guideline compared with 71.0% by the 2012 KDIGO guideline. However, only 39.1% were taking an ACEi/ARB. Thus, our findings highlight opportunities to improve blood pressure management and reduce cardiovascular risk among adults in the United States with CKD.
2021 年肾脏病：改善全球预后组织（KDIGO）慢性肾脏病（CKD）血压管理临床实践指南建议，基于标准化诊室血压测量，将目标收缩压控制在 120mmHg 以下。在这里，我们研究了与 2012 年 KDIGO 指南（蛋白尿患者目标血压 130/80mmHg 以下或无蛋白尿患者目标血压 140/90mmHg 以下）和 2017 年美国心脏病学会/美国心脏协会（目标血压低于 130/80mmHg）指南相比，该新指南对美国 CKD 成年患者降压药物治疗的潜在影响，以及 2021 年 KDIGO 指南对伴有蛋白尿（推荐收缩压 120mmHg 以上使用血管紧张素转换酶抑制剂（ACEi）或血管紧张素Ⅱ受体阻滞剂（ARB））患者的影响，与 2012 年 KDIGO 指南（推荐血压高于 130/80mmHg 时使用）相比。数据分析来自 2015-2018 年全国健康和营养调查中 1699 名 CKD 成年患者（估计肾小球滤过率 15-59ml/min/1.73m 或尿白蛋白/肌酐比值 30mg/g 或以上），并对三次标准化血压测量进行了平均处理。在 CKD 成年患者中，根据 2021 年 KDIGO 指南，69.5%的患者有降压适应证，而根据 2012 年 KDIGO 指南为 49.8%，根据 2017 年美国心脏病学会/美国心脏协会指南为 55.6%。在伴有蛋白尿的患者中，根据 2021 年 KDIGO 指南，78.2%的患者有使用 ACEi/ARB 的适应证，而根据 2012 年 KDIGO 指南为 71.0%。然而，只有 39.1%的患者正在服用 ACEi/ARB。因此，我们的研究结果突出了改善美国 CKD 成年患者血压管理和降低心血管风险的机会。
