Perneger T V, Whelton P K
Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland.
Curr Opin Nephrol Hypertens. 1993 May;2(3):395-403. doi: 10.1097/00041552-199305000-00007.
An increasing number of population-based studies and clinical trials have examined the role of blood pressure in renal disease. Recent reports indicate that elevations of blood pressure, even within the normotensive range, may result in renal damage. The available evidence suggests that blood pressure reduction diminishes and may completely prevent the progressive deterioration of renal function in persons with established renal insufficiency. Blood pressure reduction with an angiotensin-converting enzyme inhibitor may provide the best means of achieving this goal, but other antihypertensive medications may be equally effective. Nonpharmacologic interventions can be used to lower blood pressure in hypertensive persons and prevent the development of hypertension in those with blood pressure in the high-normal range. Other recent studies examined the role of environmental nephrotoxins, unrecognized viral infections, lower socioeconomic status, access to health care, and genetic factors as determinants of renal disease and hypertension in the general population. Despite their overall importance, known risk factors for hypertension-related renal disease fail to explain the excess risk of this entity in blacks and other racial minorities.
越来越多基于人群的研究和临床试验对血压在肾脏疾病中的作用进行了研究。最近的报告表明，血压升高，即使在正常血压范围内，也可能导致肾脏损害。现有证据表明，降低血压可减轻并可能完全防止已患有肾功能不全者的肾功能进行性恶化。使用血管紧张素转换酶抑制剂降低血压可能是实现这一目标的最佳方法，但其他抗高血压药物可能同样有效。非药物干预可用于降低高血压患者的血压，并预防血压处于正常高值范围者发生高血压。最近的其他研究探讨了环境肾毒素、未被识别的病毒感染、较低的社会经济地位、获得医疗保健的机会以及遗传因素作为一般人群中肾脏疾病和高血压的决定因素。尽管它们具有总体重要性，但已知的高血压相关肾脏疾病危险因素无法解释黑人和其他少数族裔中该疾病的额外风险。
