Toto R D, Mitchell H C, Pettinger W A
Department of Medicine, University of Texas Southwestern Medical Center, Dallas 75229-8856.
Curr Opin Nephrol Hypertens. 1994 May;3(3):279-85. doi: 10.1097/00041552-199405000-00008.
Over the past two decades the incidence of stroke and myocardial infarction in hypertensive populations has decreased, yet the incidence of end-stage renal disease attributed to hypertension has increased. This apparent paradox has raised questions about the adequacy of blood pressure control in hypertensive patients with renal disease. Chronic renal failure is commonly associated with hypertension, and is often severe and difficult to control, particularly in patients with hypertensive nephrosclerosis. The optimal level of blood pressure control in these patients has not been established. Long-term diastolic blood pressure control to a level lower than 90 mm Hg is associated with stable or improving renal function in hypertensive nephrosclerosis and with slowing of the deterioration in renal function from other causes of renal failure. Moreover, recent studies indicate that when blood pressure control is achieved and maintained at a level of about 130/86 mm Hg (systolic/diastolic), deterioration in renal function can be halted even in black patients with hypertensive nephrosclerosis. Therefore, in hypertensive nephrosclerosis we attempt to control diastolic blood pressure at 80 to 85 mm Hg. Newer antihypertensive agents such as calcium channel blockers and angiotensin-converting enzyme inhibitors contribute to lowering blood pressure and preserving renal function. However, they have yet to be proven superior to conventional agents in double-blind randomized clinical trials in humans with hypertensive nephrosclerosis. Importantly, minoxidil is still relied on for aggressive control of blood pressure in many patients with hypertensive nephrosclerosis.
在过去二十年中，高血压人群中风和心肌梗死的发病率有所下降，但高血压所致终末期肾病的发病率却有所上升。这一明显的矛盾引发了关于肾病高血压患者血压控制是否充分的问题。慢性肾衰竭通常与高血压相关，且往往较为严重且难以控制，尤其是在高血压性肾硬化患者中。这些患者的最佳血压控制水平尚未确定。在高血压性肾硬化中，将舒张压长期控制在低于90 mmHg的水平与肾功能稳定或改善以及减缓其他肾衰竭原因导致的肾功能恶化相关。此外，最近的研究表明，当血压控制并维持在约130/86 mmHg（收缩压/舒张压）的水平时，即使是患有高血压性肾硬化的黑人患者，肾功能恶化也可停止。因此，在高血压性肾硬化中，我们试图将舒张压控制在80至85 mmHg。新型抗高血压药物如钙通道阻滞剂和血管紧张素转换酶抑制剂有助于降低血压和保护肾功能。然而，在高血压性肾硬化患者的双盲随机临床试验中，它们尚未被证明优于传统药物。重要的是，许多高血压性肾硬化患者仍依赖米诺地尔来积极控制血压。
