心血管疾病合并慢性肾脏病的血压管理_West China Medical Journal

Authors：

 王斯 ,  陈晓平

四川大学华西医院心脏内科（成都 610041）;

Corresponding author：

王斯, Email: 27880114@qq.com; 陈晓平, Email: xiaopingchen11@126.com

Keywords：

心血管疾病; 慢性肾脏病; 血压管理; 血压靶标

DOI：

10.7507/1002-0179.201600155

Video：

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在心血管疾病的患者中，慢性肾脏病的患病率显著高于自然人群。当心血管疾病合并慢性肾脏病时，患者心血管事件的发生及死亡风险明显增加。其中，高血压是很重要的一项危险因素。慢性肾脏病患者的血压较普通高血压患者更难控制。现根据国内外最新研究进展，对心血管疾病合并慢性肾脏病的血压管理问题作一综述，主要包括如何选择最佳的血压靶标及如何选用合理的药物两方面。

Citation： 王斯, 陈晓平. 心血管疾病合并慢性肾脏病的血压管理. West China Medical Journal, 2016, 31(3): 582-585. doi: 10.7507/1002-0179.201600155 Copy

1.	陈伟伟, 高润霖, 刘力生, 等. 中国心血管病报告2013概要[J]. 中国循环杂志, 2014, 29(7) :487-491.
2.	Stevens PE, O'donoghue DJ, De Lusignan S, et al. Chronic kidney disease management in the United Kingdom:NEOERICA project results[J]. Kidney Int, 2007, 72(1) :92-99.
3.	Amenós AC, González-Juanatey JR, Gutiérrez PC, et al. Prevalence of chronic kidney disease in patients with or at a high risk of cardiovascular disease[J]. Revista Española de Cardiología (English Edition), 2010, 63(2) :225-228.
4.	Mcclellan WM, Langston RD, Presley R. Medicare patients with cardiovascular disease have a high prevalence of chronic kidney disease and a high rate of progression to end-stage renal disease[J]. J Am Soc Nephrol, 2004, 15(7) :1912-1919.
5.	Weir MR. Recognizing the Link between chronic kidney disease and cardiovascular disease[J]. Am J Manag Care, 2011, 17(Suppl 15) :S396-S402.
6.	Muntner P, Anderson A, Charleston J, et al. Hypertension awareness, treatment, and control in adults with CKD:results from the Chronic Renal Insufficiency Cohort (CRIC) Study[J]. Am J Kidney Dis, 2010, 55(3) :441-451.
7.	Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure[J]. Hypertension, 2003, 42(6) :1206-1252.
8.	Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension:The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2007, 28(12) :1462-1536.
9.	中国高血压防治指南修订委员会. 中国高血压防治指南2010[J]. 中国医学前沿杂志:电子版, 2011, 3(5) :42-93.
10.	Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease[J]. Am J Kidney Dis, 2004, 43(5 Suppl 1) :S1-290.
11.	Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension:principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group[J]. Lancet, 1998, 351(9118) :1755-1762.
12.	Lazarus JM, Bourgoignie JJ, Buckalew VM, et al. Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group[J]. Hypertension, 1997, 29(2) :641-650.
13.	Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group[J]. N Engl J Med, 1994, 330(13) :877-884.
14.	Peterson JC, Adler S, Burkart JM, et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study[J]. Ann Intern Med, 1995, 123(10) :754-762.
15.	Wright JJ, Bakris G, Greene T, et al. African American study of kidney disease and hypertension study group. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease:results from the AASK trial[J]. JAMA, 2002, 288(19) :2421-2431.
16.	Norris K, Bourgoigne J, Gassman J, et al. Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial[J]. Am J Kidney Dis, 2006, 48(5) :739-751.
17.	Ruggenenti P, Perna A, Loriga G, et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2) :multicentre, randomised controlled trial[J]. Lancet, 2005, 365(9463) :939-946.
18.	Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the progression of kidney disease:long-term follow-up of the modification of diet in renal disease study[J]. Ann Intern Med, 2005, 142(5) :342-351.
19.	Appel LJ, Wright JJ, Greene T, et al. AASK collaborative research group. Intensive blood-pressure control in hypertensive chronic kidney disease[J]. N Engl J Med, 2010, 363(10) :918-929.
20.	Upadhyay A, Earley A, Haynes SM, et al. Systematic review:blood pressure target in chronic kidney disease and proteinuria as an effect modifier[J]. Ann Intern Med, 2011, 154(8) :541-548.
21.	Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension:the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2013, 34(28) :2159-2219.
22.	James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults:report from the panel members appointed to the Eighth Joint National Committee (JNC 8) [J]. JAMA, 2014, 311(5) :507-520.
23.	Hou FF, Zhang X, Zhang GH, et al. Efficacy and safety of benazepril for advanced chronic renal insufficiency[J]. N Engl J Med, 2006, 354(2) :131-140.
24.	Sinha AD, Agarwal R. Should all hypertensive dialysis patients receive a blocker of the renin-angiotensin system?[J]. Curr Hypertens Rep, 2010, 12(5) :356-363.
25.	Mann JF, Schmieder RE, Mcqueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study):a multicentre, randomised, double-blind, controlled trial[J]. Lancet, 2008, 372(9638) :547-553.
26.	Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy[J]. N Engl J Med, 2013, 369(20) :1892-1903.
27.	Costanzo P, Perrone-Filardi P, Petretta M, et al. Calcium channel blockers and cardiovascular outcomes:a meta-analysis of 175,634 patients[J]. J Hypertens, 2009, 27(6) :1136-1151.
28.	林善锬. 钙通道阻滞药在肾科领域应用中重要问题的澄清[J]. 临床肾脏病杂志, 2010, 3:100-102.
29.	Hayashi K, Wakino S, Sugano N, et al. Ca²⁺ Channel subtypes and pharmacology in the kidney[J]. Circ Res, 2007, 100(3) :342-353.
30.	Ernst ME, Moser M. Use of diuretics in patients with hypertension[J]. N Engl J Med, 2009, 361(22) :2153-2164.
31.	Reungjui S, Hu H, Mu W, et al. Thiazide-induced subtle renal injury not observed in states of equivalent hypokalemia[J]. Kidney Int, 2007, 72(12) :1483-1492.
32.	Rahman M, Pressel S, Davis BR, et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic:a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. Arch Intern Med, 2005, 165(8) :936-946.
33.	Hawkins RG. Is population-wide diuretic use directly associated with the incidence of end-stage renal disease in the United States?[J]. Curr Hypertens Rep, 2006, 8(3) :219-225.
34.	Kaplan NM. The choice of thiazide diuretics:why chlorthalidone may replace hydrochlorothiazide[J]. Hypertension, 2009, 54(5) :951-953.
35.	Ernst ME, Carter BL, Zheng S, et al. Meta-analysis of dose-response characteristics of hydrochlorothiazide and chlorthalidone:effects on systolic blood pressure and potassium[J]. Am J Hypertens, 2010, 23(4) :440-446.
36.	Dorsch MP, Gillespie BW, Erickson SR, et al. Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide:a retrospective cohort analysis[J]. Hypertension, 2011, 57(4) :689-694.
37.	Müller K, Gamba G, Jaquet F, et al. Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA Ⅱ to Ⅳ--efficacy and quality of life[J]. Eur J Heart Fail, 2003, 5(6) :793-801.
38.	Asare K. Management of loop diuretic resistance in the intensive care unit[J]. Am J Health Syst Pharm, 2009, 66(18) :1635-1640.
39.	Heshka J, Ruzicka M, Hiremath S, et al. Spironolactone for difficult to control hypertension in chronic kidney disease:an analysis of safety and efficacy[J]. J Am Soc Hypertens, 2010, 4(6) :295-301.
40.	Yasuda G, Yatsu K, Yamamoto Y, et al. Effects of carvedilol as third-line add-on therapy on blood pressure and glucose metabolism in type 2 diabetic patients with chronic renal disease stage 3 and above[J]. Kidney Blood Press Res, 2012, 36(1) :131-138.
41.	Badve SV, Roberts MA, Hawley CM, et al. Effects of beta-adrenergic antagonists in patients with chronic kidney disease:a systematic review and meta-analysis[J]. J Am Coll Cardiol, 2011, 58(11) :1152-1161.

1. 陈伟伟, 高润霖, 刘力生, 等. 中国心血管病报告2013概要[J]. 中国循环杂志, 2014, 29(7) :487-491.
2. Stevens PE, O'donoghue DJ, De Lusignan S, et al. Chronic kidney disease management in the United Kingdom:NEOERICA project results[J]. Kidney Int, 2007, 72(1) :92-99.
3. Amenós AC, González-Juanatey JR, Gutiérrez PC, et al. Prevalence of chronic kidney disease in patients with or at a high risk of cardiovascular disease[J]. Revista Española de Cardiología (English Edition), 2010, 63(2) :225-228.
4. Mcclellan WM, Langston RD, Presley R. Medicare patients with cardiovascular disease have a high prevalence of chronic kidney disease and a high rate of progression to end-stage renal disease[J]. J Am Soc Nephrol, 2004, 15(7) :1912-1919.
5. Weir MR. Recognizing the Link between chronic kidney disease and cardiovascular disease[J]. Am J Manag Care, 2011, 17(Suppl 15) :S396-S402.
6. Muntner P, Anderson A, Charleston J, et al. Hypertension awareness, treatment, and control in adults with CKD:results from the Chronic Renal Insufficiency Cohort (CRIC) Study[J]. Am J Kidney Dis, 2010, 55(3) :441-451.
7. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure[J]. Hypertension, 2003, 42(6) :1206-1252.
8. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension:The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2007, 28(12) :1462-1536.
9. 中国高血压防治指南修订委员会. 中国高血压防治指南2010[J]. 中国医学前沿杂志:电子版, 2011, 3(5) :42-93.
10. Kidney Disease Outcomes Quality Initiative (K/DOQI). K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease[J]. Am J Kidney Dis, 2004, 43(5 Suppl 1) :S1-290.
11. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension:principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group[J]. Lancet, 1998, 351(9118) :1755-1762.
12. Lazarus JM, Bourgoignie JJ, Buckalew VM, et al. Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group[J]. Hypertension, 1997, 29(2) :641-650.
13. Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group[J]. N Engl J Med, 1994, 330(13) :877-884.
14. Peterson JC, Adler S, Burkart JM, et al. Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study[J]. Ann Intern Med, 1995, 123(10) :754-762.
15. Wright JJ, Bakris G, Greene T, et al. African American study of kidney disease and hypertension study group. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease:results from the AASK trial[J]. JAMA, 2002, 288(19) :2421-2431.
16. Norris K, Bourgoigne J, Gassman J, et al. Cardiovascular outcomes in the African American Study of Kidney Disease and Hypertension (AASK) Trial[J]. Am J Kidney Dis, 2006, 48(5) :739-751.
17. Ruggenenti P, Perna A, Loriga G, et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2) :multicentre, randomised controlled trial[J]. Lancet, 2005, 365(9463) :939-946.
18. Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the progression of kidney disease:long-term follow-up of the modification of diet in renal disease study[J]. Ann Intern Med, 2005, 142(5) :342-351.
19. Appel LJ, Wright JJ, Greene T, et al. AASK collaborative research group. Intensive blood-pressure control in hypertensive chronic kidney disease[J]. N Engl J Med, 2010, 363(10) :918-929.
20. Upadhyay A, Earley A, Haynes SM, et al. Systematic review:blood pressure target in chronic kidney disease and proteinuria as an effect modifier[J]. Ann Intern Med, 2011, 154(8) :541-548.
21. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension:the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2013, 34(28) :2159-2219.
22. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults:report from the panel members appointed to the Eighth Joint National Committee (JNC 8) [J]. JAMA, 2014, 311(5) :507-520.
23. Hou FF, Zhang X, Zhang GH, et al. Efficacy and safety of benazepril for advanced chronic renal insufficiency[J]. N Engl J Med, 2006, 354(2) :131-140.
24. Sinha AD, Agarwal R. Should all hypertensive dialysis patients receive a blocker of the renin-angiotensin system?[J]. Curr Hypertens Rep, 2010, 12(5) :356-363.
25. Mann JF, Schmieder RE, Mcqueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study):a multicentre, randomised, double-blind, controlled trial[J]. Lancet, 2008, 372(9638) :547-553.
26. Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy[J]. N Engl J Med, 2013, 369(20) :1892-1903.
27. Costanzo P, Perrone-Filardi P, Petretta M, et al. Calcium channel blockers and cardiovascular outcomes:a meta-analysis of 175,634 patients[J]. J Hypertens, 2009, 27(6) :1136-1151.
28. 林善锬. 钙通道阻滞药在肾科领域应用中重要问题的澄清[J]. 临床肾脏病杂志, 2010, 3:100-102.
29. Hayashi K, Wakino S, Sugano N, et al. Ca²⁺ Channel subtypes and pharmacology in the kidney[J]. Circ Res, 2007, 100(3) :342-353.
30. Ernst ME, Moser M. Use of diuretics in patients with hypertension[J]. N Engl J Med, 2009, 361(22) :2153-2164.
31. Reungjui S, Hu H, Mu W, et al. Thiazide-induced subtle renal injury not observed in states of equivalent hypokalemia[J]. Kidney Int, 2007, 72(12) :1483-1492.
32. Rahman M, Pressel S, Davis BR, et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic:a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. Arch Intern Med, 2005, 165(8) :936-946.
33. Hawkins RG. Is population-wide diuretic use directly associated with the incidence of end-stage renal disease in the United States?[J]. Curr Hypertens Rep, 2006, 8(3) :219-225.
34. Kaplan NM. The choice of thiazide diuretics:why chlorthalidone may replace hydrochlorothiazide[J]. Hypertension, 2009, 54(5) :951-953.
35. Ernst ME, Carter BL, Zheng S, et al. Meta-analysis of dose-response characteristics of hydrochlorothiazide and chlorthalidone:effects on systolic blood pressure and potassium[J]. Am J Hypertens, 2010, 23(4) :440-446.
36. Dorsch MP, Gillespie BW, Erickson SR, et al. Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide:a retrospective cohort analysis[J]. Hypertension, 2011, 57(4) :689-694.
37. Müller K, Gamba G, Jaquet F, et al. Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA Ⅱ to Ⅳ--efficacy and quality of life[J]. Eur J Heart Fail, 2003, 5(6) :793-801.
38. Asare K. Management of loop diuretic resistance in the intensive care unit[J]. Am J Health Syst Pharm, 2009, 66(18) :1635-1640.
39. Heshka J, Ruzicka M, Hiremath S, et al. Spironolactone for difficult to control hypertension in chronic kidney disease:an analysis of safety and efficacy[J]. J Am Soc Hypertens, 2010, 4(6) :295-301.
40. Yasuda G, Yatsu K, Yamamoto Y, et al. Effects of carvedilol as third-line add-on therapy on blood pressure and glucose metabolism in type 2 diabetic patients with chronic renal disease stage 3 and above[J]. Kidney Blood Press Res, 2012, 36(1) :131-138.
41. Badve SV, Roberts MA, Hawley CM, et al. Effects of beta-adrenergic antagonists in patients with chronic kidney disease:a systematic review and meta-analysis[J]. J Am Coll Cardiol, 2011, 58(11) :1152-1161.

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