Hypertension Research Foundation (M.B.), University of Lausanne, Switzerland.
Faculty of Biology and Medicine (M.B.), University of Lausanne, Switzerland.
Circ Res. 2023 Apr 14;132(8):1050-1063. doi: 10.1161/CIRCRESAHA.122.321762. Epub 2023 Apr 13.
Hypertension is the leading modifiable cause of premature death and hence one of the global targets of World Health Organization for prevention. Hypertension also affects the great majority of patients with chronic kidney disease (CKD). Both hypertension and CKD are intrinsically related, as hypertension is a strong determinant of worse renal and cardiovascular outcomes and renal function decline aggravates hypertension. This bidirectional relationship is well documented by the high prevalence of hypertension across CKD stages and the dual benefits of effective antihypertensive treatments on renal and cardiovascular risk reduction. Achieving an optimal blood pressure (BP) target is mandatory and requires several pharmacological and lifestyle measures. However, it also requires a correct diagnosis based on reliable BP measurements (eg, 24-hour ambulatory BP monitoring, home BP), especially for populations like patients with CKD where reduced or reverse dipping patterns or masked and resistant hypertension are frequent and associated with a poor cardiovascular and renal prognosis. Even after achieving BP targets, which remain debated in CKD, the residual cardiovascular risk remains high. Current antihypertensive options have been enriched with novel agents that enable to lower the existing renal and cardiovascular risks, such as SGLT2 (sodium-glucose cotransporter-2) inhibitors and novel nonsteroidal mineralocorticoid receptor antagonists. Although their beneficial effects may be driven mostly from actions beyond BP control, recent evidence underline potential improvements on abnormal 24-hour BP phenotypes such as nondipping. Other promising novelties are still to come for the management of hypertension in CKD. In the present review, we shall discuss the existing evidence of hypertension as a cardiovascular risk factor in CKD, the importance of identifying hypertension phenotypes among patients with CKD, and the traditional and novel aspects of the management of hypertensives with CKD.
高血压是导致过早死亡的主要可改变原因，因此也是世界卫生组织预防的全球目标之一。高血压也影响绝大多数慢性肾脏病（CKD）患者。高血压和 CKD 本质上是相关的，因为高血压是肾脏和心血管结局恶化的强决定因素，肾功能下降会加重高血压。高血压在 CKD 各个阶段的高患病率以及有效的降压治疗对肾脏和心血管风险降低的双重益处充分证明了这种双向关系。实现最佳血压（BP）目标是强制性的，需要采取多种药理学和生活方式措施。然而，这还需要基于可靠的 BP 测量（例如 24 小时动态血压监测、家庭 BP）进行正确诊断，尤其是在 CKD 患者等人群中，这些患者的血压模式往往是减少或反向下降、隐匿性和耐药性高血压，与较差的心血管和肾脏预后相关。即使在 CKD 中达到 BP 目标，剩余的心血管风险仍然很高。目前的降压选择已经增加了新型药物，这些药物可以降低现有的肾脏和心血管风险，例如 SGLT2（钠-葡萄糖共转运蛋白-2）抑制剂和新型非甾体类盐皮质激素受体拮抗剂。尽管它们的有益作用可能主要是通过超越血压控制的作用驱动的，但最近的证据强调了对异常 24 小时 BP 表型（如非杓型）的潜在改善。其他有前途的新方法仍将用于 CKD 患者的高血压管理。在本次综述中，我们将讨论高血压作为 CKD 心血管危险因素的现有证据、在 CKD 患者中确定高血压表型的重要性以及 CKD 高血压患者的传统和新型管理方法。
