Lazarus J M, Bourgoignie J J, Buckalew V M, Greene T, Levey A S, Milas N C, Paranandi L, Peterson J C, Porush J G, Rauch S, Soucie J M, Stollar C
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md, USA.
Hypertension. 1997 Feb;29(2):641-50. doi: 10.1161/01.hyp.29.2.641.
The Modification of Diet in Renal Disease Study showed a beneficial effect of a lower-than-usual blood pressure (BP) goal on the progression of renal disease in patients with proteinuria. The purpose of the present analyses was to examine the achieved BP, baseline characteristics that helped or hindered achievement of the BP goals, and safety of the BP interventions. Five hundred eighty-five patients with baseline glomerular filtration rate between 13 and 55 mL/min per 1.73 m2 (0.22 to 0.92 mL/s per 1.73 m2) were randomly assigned to either a usual or low BP goal (mean arterial pressure < or = 107 or < or = 92 mm Hg, respectively). Few patients had a history of cardiovascular disease. All antihypertensive agents were permitted, but angiotensin-converting enzyme inhibitors (with or without diuretics) followed by calcium channel blockers were preferred. The mean (+/- SD) of the mean arterial pressures during follow-up in the low and usual BP groups was 93.0 +/- 7.3 and 97.7 +/- 7.7 mm Hg, respectively. Follow-up BP was significantly higher in subgroups of patients with preexisting hypertension, baseline mean arterial pressure > 92 mm Hg, a diagnosis of polycystic kidney disease or glomerular diseases, baseline urinary protein excretion > 1 g/d, age > or = 61 years, and black race. The frequency of medication changes and incidence of symptoms of low BP were greater in the low BP group, but there were no significant differences between BP groups in stop points, hospitalizations, or death. When data from both groups were combined, each 1-mm Hg increase in follow-up systolic BP was associated with a 1.35-times greater risk of hospitalization for cardiovascular or cerebrovascular disease. Lower BP than usually recommended for the prevention of cardiovascular disease is achievable by several medication regimens without serious adverse effects in patients with chronic renal disease without cardiovascular disease. For patients with urinary protein excretion > 1 g/d, target BP should be a mean arterial pressure of < or = 92 mm Hg, equivalent to 125/75 mm Hg.
肾脏疾病饮食调整研究表明，低于常规的血压（BP）目标对蛋白尿患者的肾脏疾病进展具有有益影响。本分析的目的是检查所达到的血压、有助于或阻碍实现血压目标的基线特征以及血压干预措施的安全性。585例基线肾小球滤过率在每1.73平方米13至55毫升/分钟（每1.73平方米0.22至0.92毫升/秒）之间的患者被随机分配至常规或低血压目标组（平均动脉压分别≤107或≤92毫米汞柱）。很少有患者有心血管疾病史。所有抗高血压药物均被允许使用，但首选血管紧张素转换酶抑制剂（加或不加利尿剂），其次是钙通道阻滞剂。低血压组和常规血压组随访期间平均动脉压的均值（±标准差）分别为93.0±7.3和97.7±7.7毫米汞柱。在已患高血压、基线平均动脉压>92毫米汞柱、诊断为多囊肾病或肾小球疾病、基线尿蛋白排泄>1克/天、年龄≥61岁以及黑人种族的患者亚组中，随访血压显著更高。低血压组药物变更频率和低血压症状发生率更高，但两组在停药点、住院或死亡方面无显著差异。当两组数据合并时，随访收缩压每升高1毫米汞柱，心血管或脑血管疾病住院风险增加1.35倍。通过几种药物治疗方案可实现低于预防心血管疾病通常推荐水平的血压，且对无心血管疾病的慢性肾病患者无严重不良反应。对于尿蛋白排泄>1克/天的患者，目标血压应为平均动脉压≤92毫米汞柱，相当于125/75毫米汞柱。
