Wight J P, Brown C B, el Nahas A M
Sheffield Kidney Institute, Northern General Hospital, UK.
Clin Nephrol. 1993 Jun;39(6):305-11.
This study assesses the direct effect of different degrees of blood pressure control on the progression of chronic renal failure (CRF) in 18 patients with nephropathies of varying etiology (Glomerular filtration rate [GFR]: 14.99 +/- 5.94 ml/min/1.73 m2). The study involves three consecutive phases; Phase 1 consisted of a retrospective analysis of blood pressure and biochemical data: mean diastolic blood pressure (MDBP) was 89.9 +/- 7.9 mmHg and the mean rate of decline in renal function was -68.9 1/mol of creatinine/month. Phase 2 consisted of a 6 months prospective period of frequent (monthly) follow-up and optimization of blood pressure control when MDBP was reduced to 83.9 +/- 6.5 mmHg (p < 0.001 cf phase 1) and the rate of decline in renal function fell to -25.2 1/mol/month (p < 0.05 cf phase 1). Phase 3 consisted of another 6-month period when further reduction of MDBP 77.1 +/- 6.6 mmHg (p < 0.01 cf phase 2) was brought about by the addition of the calcium antagonist nifedipine (10 mg thrice/daily). This was not associated with further improvement in the rate of decline of renal function as in this phase the rate of decline was -53.2 1/mol/month. This study confirms that frequent follow-ups with improved blood pressure control slow the rate of decline in renal function. Further reduction of diastolic blood pressure to below 80-85 mmHg could not be shown to confer additional benefit.
本研究评估了不同程度的血压控制对18例病因各异的肾病患者（肾小球滤过率[GFR]：14.99±5.94 ml/min/1.73 m²）慢性肾衰竭（CRF）进展的直接影响。该研究包括三个连续阶段；第一阶段包括对血压和生化数据的回顾性分析：平均舒张压（MDBP）为89.9±7.9 mmHg，肾功能平均下降速率为-68.9 μmol肌酐/月。第二阶段包括一个为期6个月的前瞻性频繁（每月）随访期，当MDBP降至83.9±6.5 mmHg（与第一阶段相比，p<0.001）且肾功能下降速率降至-25.2 μmol/月（与第一阶段相比，p<0.05）时进行血压控制优化。第三阶段包括另一个为期6个月的时期，通过加用钙拮抗剂硝苯地平（10 mg，每日三次）使MDBP进一步降至77.1±6.6 mmHg（与第二阶段相比，p<0.01）。这并未伴随肾功能下降速率的进一步改善，因为在此阶段下降速率为-53.2 μmol/月。本研究证实，通过频繁随访改善血压控制可减缓肾功能下降速率。未显示将舒张压进一步降至80 - 85 mmHg以下能带来额外益处。
