Zhang Wei, Li Yan, Wang Ji-Guang
Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Clin Hypertens (Greenwich). 2024 Dec;26(12):1375-1383. doi: 10.1111/jch.14924. Epub 2024 Nov 4.
Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors are a new class of agents for the treatment of anemia in chronic kidney disease (CKD). Unlike traditional treatments such as erythropoiesis-stimulating agents (ESAs), HIF-PH inhibitors are orally administered drugs and may increase endogenous erythropoietin and improve iron homeostasis. However, a significant concern is their possible side effect on blood pressure. The current mini-review summarizes the data of 26 randomized controlled (placebo or ESAs) trials on six different HIF-PH inhibitors with regard to their potential influence on blood pressure and hypertension in the management of anemia in CKD. Overall, the use of HIF-PH inhibitors was associated with a higher risk of hypertension than placebo (pooled risk ratio 1.36, 95% confidence interval [CI] 1.16-1.59), but a lower risk of hypertension than ESA treatment (pooled risk ratio 0.92, 95% CI 0.86-0.98), especially in CKD patients not undergoing dialysis (pooled risk ratio 0.85, 95% CI 0.73-0.98). This review highlights the importance of blood pressure monitoring during the treatment of HIF-PH inhibitors, especially out-of-office blood pressure measurement.
缺氧诱导因子脯氨酰羟化酶（HIF-PH）抑制剂是一类用于治疗慢性肾脏病（CKD）贫血的新型药物。与促红细胞生成素（ESA）等传统治疗方法不同，HIF-PH抑制剂为口服药物，可增加内源性促红细胞生成素并改善铁稳态。然而，人们高度关注其对血压可能产生的副作用。本综述总结了26项关于六种不同HIF-PH抑制剂的随机对照（安慰剂或ESA）试验数据，这些试验涉及它们在CKD贫血管理中对血压和高血压的潜在影响。总体而言，与安慰剂相比，使用HIF-PH抑制剂会增加高血压风险（合并风险比1.36，95%置信区间[CI] 1.16 - 1.59），但与ESA治疗相比，高血压风险较低（合并风险比0.92，95% CI 0.86 - 0.98），尤其是在未接受透析的CKD患者中（合并风险比0.85，95% CI 0.73 - 0.98）。本综述强调了在HIF-PH抑制剂治疗期间进行血压监测的重要性，尤其是诊室外血压测量。
