Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
Br J Hosp Med (Lond). 2022 May 2;83(5):1-11. doi: 10.12968/hmed.2021.0440. Epub 2022 May 27.
Hypertension is a leading risk factor for cardiovascular disease and all-cause mortality globally. Hypertension and chronic kidney disease are closely intertwined conditions as hypertension can lead to deteriorating renal function and progressive chronic kidney disease can contribute to worsening hypertension. In the setting of chronic kidney disease, the pathophysiology of hypertension is complex and involves the interplay of many factors including a reduced number of functioning nephrons, sodium retention and volume expansion, upregulation of the sympathetic nervous system, hormonal factors such as upregulation of the renin-angiotensin-aldosterone system, and endothelial dysfunction. Poorly controlled hypertension can accelerate the progression to end-stage kidney disease. This review discusses the pathophysiological mechanisms that contribute to hypertension, including sympathetic nervous system activity, the renin-angiotensin-aldosterone system and the role of sodium. In the setting of chronic kidney disease, the relationship with hypertension and renovascular disease as a potential cause and target for therapeutic intervention is briefly reviewed. Finally, treatment options, targets and the long-term cardiovascular benefits of optimal blood pressure control are discussed.
高血压是全球心血管疾病和全因死亡率的主要危险因素。高血压和慢性肾脏病密切相关，因为高血压可导致肾功能恶化，而进展性慢性肾脏病可导致高血压恶化。在慢性肾脏病中，高血压的病理生理学较为复杂，涉及多种因素的相互作用，包括功能肾单位数量减少、钠潴留和容量扩张、交感神经系统的上调、激素因素（如肾素-血管紧张素-醛固酮系统的上调）以及内皮功能障碍。未得到有效控制的高血压会加速进展为终末期肾病。本篇综述讨论了导致高血压的病理生理机制，包括交感神经系统活动、肾素-血管紧张素-醛固酮系统以及钠的作用。在慢性肾脏病中，简要回顾了与高血压的关系以及血管性疾病作为潜在的病因和治疗干预靶点。最后，讨论了治疗选择、目标以及最佳血压控制的长期心血管获益。
