亚洲慢性肾脏病患者的血压管理

发布时间：2018-07-17 18:32

【摘要】：高血压既是慢性肾脏病(CKD)的原因也是CKD的结果。根据我国一项调查,高血压患者CKD患病率高于普通人群。高血压患者中CKD是肾脏及其他重要脏器的危险因素。可能是高盐膳食的原因,高血压合并CKD患者夜间血压不下降或升高的患病率高,并可能有更高的心血管病风险。因此,需要进行诊室外血压评估及全面心血管评估。目前大部分高血压指南推荐高血压合并CKD患者积极降血压治疗。这对亚洲人心血管病的预防更为重要,因为在亚洲,脑卒中与血压更相关,是高血压的主要并发症。预防CKD进展及心血管并发症通常需要强化降压,将血压控制到130/80mm Hg。肾素血管紧张素系统(RAS)阻断剂被推荐作为估算的肾小球滤过率30mL/(min·1.73m~2)患者的一线降压药物,可预防终末期肾病及心血管事件。然而,将血压控制达标通常需要RAS阻断剂与其他类降压药(如钙拮抗剂、利尿剂等)联合治疗。
[Abstract]:Hypertension is not only the cause of chronic kidney disease (CKD), but also the result of CKD. According to a survey in China, the prevalence of CKD in hypertensive patients is higher than that in the general population. CKD is a risk factor for kidney and other important organs in hypertensive patients. It may be the cause of high salt diet, hypertension patients with CKD have a high incidence of nocturnal blood pressure not decreasing or rising, and may have a higher risk of cardiovascular disease. Therefore, there is a need for an out-of-office blood pressure assessment and a comprehensive cardiovascular assessment. Most hypertension guidelines recommend active hypotension therapy in patients with hypertension associated with CKD. This is even more important for the prevention of cardiovascular disease in Asians, where stroke is more associated with blood pressure and is a major complication of hypertension. Prevention of CKD progression and cardiovascular complications usually requires enhanced hypotension to control blood pressure to 130/80mm Hg. Renin angiotensin system (Ras) blockers are recommended as first-line antihypertensive drugs for estimating glomerular filtration rate at 30 mL / (min 1.73m~2) to prevent end-stage nephropathy and cardiovascular events. However, controlling blood pressure often requires a combination of Ras blockers and other antihypertensive drugs, such as calcium antagonists, diuretics, etc.
【作者单位】：上海交通大学医学院附属瑞金医院临床试验与流行病学研究中心上海市高血压研究所;
【分类号】：R544.1;R692

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