Banerjee Debasish, Winocour Peter, Chowdhury Tahseen A, De Parijat, Wahba Mona, Montero Rosa, Fogarty Damian, Frankel Andrew, Goldet Gabrielle, Karalliedde Janaka, Mark Patrick B, Patel Dipesh, Pokrajac Ana, Sharif Adnan, Zac-Varghese Sagen, Bain Stephen, Dasgupta Indranil
St. George's Hospitals NHS Foundation Trust, London, UK.
ENHIDE, East and North Hertfordshire NHS Trust, Stevenage, UK.
Kidney Int Rep. 2022 Jan 13;7(4):681-687. doi: 10.1016/j.ekir.2022.01.004. eCollection 2022 Apr.
Diabetic kidney disease (DKD) accounts for >40% cases of chronic kidney disease (CKD) globally. Hypertension is a major risk factor for progression of DKD and the high incidence of cardiovascular disease and mortality in these people. Meticulous management of hypertension is therefore crucial to slow down the progression of DKD and reduce cardiovascular risk. Randomized controlled trial evidence differs in type 1 and type 2 diabetes and in different stages of DKD in terms of target blood pressure (BP). Renin-angiotensin blocking agents reduce progression of DKD and cardiovascular events in both type 1 and type 2 diabetes, albeit differently according to the stage of CKD. There is emerging evidence for the benefit of sodium glucose cotransporter 2, nonsteroidal selective mineralocorticoid antagonists, and endothelin-A receptor antagonists in slowing progression and reducing cardiovascular events in DKD. This UK guideline, developed jointly by diabetologists and nephrologists, has reviewed all available current evidence regarding the management of hypertension in DKD to produce a set of comprehensive individualized recommendations for BP control and the use of antihypertensive agents according to age, type of diabetes, and stage of CKD (https://ukkidney.org/sites/renal.org/files/Management-of-hypertension-and-RAAS-blockade-in-adults-with-DKD.pdf). A succinct summary of the guideline, including an infographic, is presented here.
糖尿病肾病（DKD）在全球慢性肾脏病（CKD）病例中占比超过40%。高血压是DKD进展以及这些患者心血管疾病高发病率和高死亡率的主要危险因素。因此，精心管理高血压对于减缓DKD进展和降低心血管风险至关重要。在目标血压（BP）方面，1型和2型糖尿病以及DKD不同阶段的随机对照试验证据存在差异。肾素 - 血管紧张素阻断剂可减缓1型和2型糖尿病中DKD的进展并减少心血管事件，尽管根据CKD阶段的不同作用方式有所不同。有新证据表明，钠 - 葡萄糖协同转运蛋白2抑制剂、非甾体选择性盐皮质激素拮抗剂和内皮素 - A受体拮抗剂在减缓DKD进展和减少心血管事件方面具有益处。本英国指南由糖尿病专家和肾病专家联合制定，回顾了所有关于DKD高血压管理的现有证据，以根据年龄、糖尿病类型和CKD阶段制定一套全面的个体化血压控制和使用抗高血压药物的建议（https://ukkidney.org/sites/renal.org/files/Management-of-hypertension-and-RAAS-blockade-in-adults-with-DKD.pdf）。此处呈现该指南的简要总结，包括一张信息图表。
