Cice Gennaro, Monzo Luca, Calo Leonardo
Department of Cardiology, Policlinico Casilino, Rome, Italy.
Sapienza University, Rome, Italy.
Eur Heart J Suppl. 2020 Nov 18;22(Suppl L):L44-L48. doi: 10.1093/eurheartj/suaa133. eCollection 2020 Nov.
High blood pressure (BP) is a leading cause of chronic kidney disease (CKD) and at the same time represents its most frequent complication. High BP is an independent risk factor for advanced CKD; on the other hand, at least 40% of patients with normal glomerular filtration rate (GFR) and virtually all patients with GFR <30 mL/min are hypertensive. CKD and microalbuminuria are powerful risk factors for cardiovascular morbidity and mortality. Consequently, in uraemic hypertension, it is of utmost importance to carefully manage both high BP and microalbuminuria, in order to slow down the progression of kidney damage and to reduce the incidence of cardiovascular events. The first purpose of the medical treatment in hypertensive patients is to normalize BP, regardless of the drug used. Nevertheless, some drugs have an 'additional' nephroprotective effect at the same BP target achieved. In this regard, first-line drugs are definitely renin-angiotensin-aldosterone inhibitors, mainly for their proved efficacy in reducing hypertension-related kidney damage and proteinuria. Anyway, a combined approach (two or more drugs) is usually needed to achieve the optimal BP target and reduce the worsening of CKD.
高血压是慢性肾脏病（CKD）的主要病因，同时也是其最常见的并发症。高血压是晚期CKD的独立危险因素；另一方面，至少40%肾小球滤过率（GFR）正常的患者以及几乎所有GFR<30 mL/min的患者患有高血压。CKD和微量白蛋白尿是心血管发病和死亡的强大危险因素。因此，在尿毒症性高血压中，谨慎控制高血压和微量白蛋白尿至关重要，以便减缓肾脏损害的进展并降低心血管事件的发生率。高血压患者药物治疗的首要目的是使血压正常化，无论使用何种药物。然而，在达到相同血压目标的情况下，一些药物具有“额外的”肾脏保护作用。在这方面，一线药物肯定是肾素-血管紧张素-醛固酮抑制剂，主要是因为它们在减少高血压相关肾脏损害和蛋白尿方面已证实的疗效。无论如何，通常需要联合用药（两种或更多药物）来实现最佳血压目标并减少CKD的恶化。
