Siewert-Delle A, Ljungman S, Andersson O K, Wilhelmsen L
Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden.
Nephrol Dial Transplant. 1998 Dec;13(12):3084-90. doi: 10.1093/ndt/13.12.3084.
Hypertension is reported to be one of the most common causes of end-stage renal disease (ESRD) in Europe and in the United States. However, the frequency with which treated primary hypertension leads to renal failure is not known. The majority of patients with ESRD have hypertension. Whether this is the cause or the consequence of the impaired renal function is often not possible to establish.
To determine if treated primary hypertension can lead to ESRD, we studied the development of serum creatinine levels in 686 white hypertensive men, recruited from a random third of the male population aged 47-55 years living in Göteborg, Sweden (n=9998; 7495 participants). At entry and during 20 years follow-up, all signs of kidney disease, secondary hypertension, or increase in blood pressure were investigated. Records of patients with a serum creatinine value > or = 130 micromol/l at any time during the observation period were thoroughly studied to ascertain the cause of the impaired renal function.
A serum creatinine level above 130 micromol was seen in 8.9% (61/686) of the treated hypertensives during the 20 years of follow-up. An underlying renal disorder was found in 7.2% (49/686) of the patients; renoparenchymal disease (2.2%), renovascular disease (1.5%), diabetic nephropathy (1.2%) or a urological disease (1.6%). Only 1.7% (12/686) of the hypertensives showed a moderate progressive increase in serum creatinine of unknown cause. The serum creatinine in this group was 133+/-8 micromol/l (mean+/-SD; range 124-144) after 15 years and 139+/-7 micromol/l (range 132-151) after 20 years. Thus, none of these patients aged 66-71 years had developed ESRD or a clinically important reduction in renal function.
The main finding in this population-based study of white middle-aged men with primary nonmalignant hypertension was that long-term antihypertensive treatment was not associated with development of end-stage renal disease or even an abnormal progressive decline in kidney function.
据报道，高血压是欧洲和美国终末期肾病（ESRD）最常见的病因之一。然而，经治疗的原发性高血压导致肾衰竭的频率尚不清楚。大多数ESRD患者患有高血压。这是肾功能受损的原因还是结果往往难以确定。
为了确定经治疗的原发性高血压是否会导致ESRD，我们研究了从瑞典哥德堡年龄在47 - 55岁的男性人群中随机抽取的三分之一（n = 9998；7495名参与者）中的686名白人高血压男性血清肌酐水平的变化情况。在入组时以及20年的随访期间，对所有肾脏疾病、继发性高血压或血压升高的迹象进行了调查。对观察期内任何时间血清肌酐值≥130微摩尔/升的患者记录进行了深入研究，以确定肾功能受损的原因。
在20年的随访期间，8.9%（61/686）的经治疗高血压患者血清肌酐水平高于130微摩尔。7.2%（49/686）的患者存在潜在的肾脏疾病；肾实质疾病（2.2%）、肾血管疾病（1.5%）、糖尿病肾病（1.2%）或泌尿系统疾病（1.6%）。只有1.7%（12/686）的高血压患者血清肌酐出现中度不明原因的进行性升高。该组患者15年后血清肌酐为133±8微摩尔/升（平均值±标准差；范围124 - 144），20年后为139±7微摩尔/升（范围132 - 151）。因此，这些年龄在66 - 71岁的患者中没有一人发展为ESRD或出现临床上重要的肾功能下降。
在这项基于人群的白人中年原发性非恶性高血压男性研究中的主要发现是，长期抗高血压治疗与终末期肾病的发生甚至肾功能异常进行性下降无关。
