Interpretation of guidelines for hypertension in chronic kidney disease_West China Medical Journal

Authors：

DANG Xilong ,  JIANG Hongli

Department of Blood Purification, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi 710061, P. R. China;

Corresponding author：

JIANG Hongli, Email: j92106@sina.com

Keywords：

Chronic kidney disease; Hypertension; Guideline; Interpretation

DOI：

10.7507/1002-0179.201906023

Video：

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Chronic kidney disease (CKD) and hypertension are very common chronic diseases. Active and standardized treatment of hypertension in patients with CKD can not only delay the progress of renal disease, but also reduce the risk of cardiovascular events. In recent years, although the guidelines for hypertension have put forward detailed suggestions for the management of hypertension in CKD patients, there are differences in the recommendation of blood pressure target value for CKD patients. Combined with the latest guidelines, this review interprets the blood pressure measurement methods, diagnostic criteria, antihypertensive targets and drug therapy in patients with CKD.

Citation： DANG Xilong, JIANG Hongli. Interpretation of guidelines for hypertension in chronic kidney disease. West China Medical Journal, 2019, 34(7): 746-751. doi: 10.7507/1002-0179.201906023 Copy

1.	Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
2.	Yan Z, Wang Y, Li S, et al. Hypertension control in adults with CKD in China: baseline results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). Am J Hypertens, 2018, 31(4): 486-494.
3.	Shafi T, Waheed S, Zager PG. Hypertension in hemodialysis patients: an opinion-based update. Semin Dial, 2014, 27(2): 146-153.
4.	Chang AR, Lóser M, Malhotra R, et al. Blood pressure goals in patients with CKD: a review of evidence and guidelines. Clin J Am Soc Nephrol, 2019, 14(1): 161-169.
5.	中国高血压防治指南修订委员会. 中国高血压防治指南(2018年修订版). 北京: 中国医药科技出版社, 2018.
6.	Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2018, 138(17): e426-e483.
7.	中国医师协会肾脏内科医师分会, 中国中西医结合学会肾脏疾病专业委员会. 中国肾性高血压管理指南2016(简版). 中华医学杂志, 2017, 97(20): 1547-1555.
8.	Myers MG, Godwin M. Automated office blood pressure. Can J Cardiol, 2012, 28(3): 341-346.
9.	刘星. 动态血压评价慢性肾脏病合并高血压患者的血压节律及降压的时间治疗学研究. 长沙: 中南大学, 2014.
10.	Ataş N, Erten Y, Okyay GU, et al. Left ventricular hypertrophy and blood pressure control in automated and continuous ambulatory peritoneal dialysis patients. Ther Apher Dial, 2014, 18(3): 297-304.
11.	Sarafidis PA, Persu A, Agarwal R, et al. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH). Nephrol Dial Transplant, 2017, 32(4): 620-640.
12.	SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med, 2015, 373(22): 2103-2116.
13.	Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA, 2016, 315(24): 2673-2682.
14.	Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet, 2014, 383(9932): 1899-1911.
15.	Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol, 2017, 2(7): 775-781.
16.	Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation, 2018, 137(2): 109-118.
17.	张宇清, 陈肯. 对2017年美国新版高血压指南的解读与思考. 中国循环杂志, 2018, 33(2): 107-109.
18.	Tsai WC, Wu HY, Peng YS, et al. Association of intensive blood pressure control and kidney disease progression in nondiabetic patients with chronic kidney disease: a systematic review and meta-analysis. JAMA Intern Med, 2017, 177(6): 792-799.
19.	Zanchetti A, Hansson L, Clement D, et al. Benefits and risks of more intensive blood pressure lowering in hypertensive patients of the HOT study with different risk profiles: does a J-shaped curve exist in smokers?. J Hypertens, 2003, 21(4): 797-804.
20.	Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med, 2010, 362(17): 1575-1585.
21.	Lonn EM, Bosch J, López-Jaramillo P, et al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med, 2016, 374(21): 2009-2020.
22.	Viazzi F, Piscitelli P, Ceriello A, et al. Resistant hypertension, time-updated blood pressure values and renal outcome in type 2 diabetes mellitus. J Am Heart Assoc, 2017, 6(9): e006745.
23.	Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet, 2017, 390(10112): 2549-2558.
24.	Zheng Y, Cai GY, Chen XM, et al. Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients. Chin Med J (Engl), 2013, 126(12): 2276-2280.
25.	Wang X, Qin X, Demirtas H, et al. Efficacy of folic acid supplementation in stroke prevention: a meta-analysis. Lancet, 2007, 369(9576): 1876-1882.
26.	Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl, 2012, 2(5): 337-414.
27.	王鸿懿, 孙宁玲. 2014美国成人高血压管理指南介绍. 中国医学前沿杂志(电子版), 2014, 6(1): 74-82.
28.	K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis, 2005, 45(4 Suppl 3): S1-S153.
29.	Tentori F, Hunt WC, Rohrscheib M, et al. Which targets in clinical practice guidelines are associated with improved survival in a large dialysis organization?. J Am Soc Nephrol, 2007, 18(8): 2377-2384.
30.	Robinson BM, Tong L, Zhang J, et al. Blood pressure levels and mortality risk among hemodialysis patients in the dialysis outcomes and practice patterns study. Kidney Int, 2012, 82(5): 570-580.
31.	中国医师协会肾脏病医师分会血液透析充分性协作组. 中国血液透析充分性临床实践指南. 中华医学杂志, 2015, 95(34): 2748-2753.
32.	Leenen FH, Nwachuku CE, Black HR, et al. Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension, 2006, 48(3): 374-384.
33.	Agarwal R, Sinha AD, Pappas MK, et al. Hypertension in hemodialysis patients treated with atenolol or lisinopril: a randomized controlled trial. Nephrol Dial Transplant, 2014, 29(3): 672-681.
34.	Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet, 2015, 386(10008): 2059-2068.
35.	Lopes AA, Bragg-Gresham JL, Ramirez SP, et al. Prescription of antihypertensive agents to haemodialysis patients: time trends and associations with patient characteristics, country and survival in the DOPPS. Nephrol Dial Transplant, 2009, 24(9): 2809-2816.
36.	Liu Y, Ma X, Zheng J, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials. BMC Nephrol, 2017, 18(1): 206.

1. Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet, 2012, 379(9818): 815-822.
2. Yan Z, Wang Y, Li S, et al. Hypertension control in adults with CKD in China: baseline results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). Am J Hypertens, 2018, 31(4): 486-494.
3. Shafi T, Waheed S, Zager PG. Hypertension in hemodialysis patients: an opinion-based update. Semin Dial, 2014, 27(2): 146-153.
4. Chang AR, Lóser M, Malhotra R, et al. Blood pressure goals in patients with CKD: a review of evidence and guidelines. Clin J Am Soc Nephrol, 2019, 14(1): 161-169.
5. 中国高血压防治指南修订委员会. 中国高血压防治指南(2018年修订版). 北京: 中国医药科技出版社, 2018.
6. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2018, 138(17): e426-e483.
7. 中国医师协会肾脏内科医师分会, 中国中西医结合学会肾脏疾病专业委员会. 中国肾性高血压管理指南2016(简版). 中华医学杂志, 2017, 97(20): 1547-1555.
8. Myers MG, Godwin M. Automated office blood pressure. Can J Cardiol, 2012, 28(3): 341-346.
9. 刘星. 动态血压评价慢性肾脏病合并高血压患者的血压节律及降压的时间治疗学研究. 长沙: 中南大学, 2014.
10. Ataş N, Erten Y, Okyay GU, et al. Left ventricular hypertrophy and blood pressure control in automated and continuous ambulatory peritoneal dialysis patients. Ther Apher Dial, 2014, 18(3): 297-304.
11. Sarafidis PA, Persu A, Agarwal R, et al. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH). Nephrol Dial Transplant, 2017, 32(4): 620-640.
12. SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med, 2015, 373(22): 2103-2116.
13. Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA, 2016, 315(24): 2673-2682.
14. Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet, 2014, 383(9932): 1899-1911.
15. Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol, 2017, 2(7): 775-781.
16. Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation, 2018, 137(2): 109-118.
17. 张宇清, 陈肯. 对2017年美国新版高血压指南的解读与思考. 中国循环杂志, 2018, 33(2): 107-109.
18. Tsai WC, Wu HY, Peng YS, et al. Association of intensive blood pressure control and kidney disease progression in nondiabetic patients with chronic kidney disease: a systematic review and meta-analysis. JAMA Intern Med, 2017, 177(6): 792-799.
19. Zanchetti A, Hansson L, Clement D, et al. Benefits and risks of more intensive blood pressure lowering in hypertensive patients of the HOT study with different risk profiles: does a J-shaped curve exist in smokers?. J Hypertens, 2003, 21(4): 797-804.
20. Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med, 2010, 362(17): 1575-1585.
21. Lonn EM, Bosch J, López-Jaramillo P, et al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med, 2016, 374(21): 2009-2020.
22. Viazzi F, Piscitelli P, Ceriello A, et al. Resistant hypertension, time-updated blood pressure values and renal outcome in type 2 diabetes mellitus. J Am Heart Assoc, 2017, 6(9): e006745.
23. Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet, 2017, 390(10112): 2549-2558.
24. Zheng Y, Cai GY, Chen XM, et al. Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients. Chin Med J (Engl), 2013, 126(12): 2276-2280.
25. Wang X, Qin X, Demirtas H, et al. Efficacy of folic acid supplementation in stroke prevention: a meta-analysis. Lancet, 2007, 369(9576): 1876-1882.
26. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl, 2012, 2(5): 337-414.
27. 王鸿懿, 孙宁玲. 2014美国成人高血压管理指南介绍. 中国医学前沿杂志(电子版), 2014, 6(1): 74-82.
28. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis, 2005, 45(4 Suppl 3): S1-S153.
29. Tentori F, Hunt WC, Rohrscheib M, et al. Which targets in clinical practice guidelines are associated with improved survival in a large dialysis organization?. J Am Soc Nephrol, 2007, 18(8): 2377-2384.
30. Robinson BM, Tong L, Zhang J, et al. Blood pressure levels and mortality risk among hemodialysis patients in the dialysis outcomes and practice patterns study. Kidney Int, 2012, 82(5): 570-580.
31. 中国医师协会肾脏病医师分会血液透析充分性协作组. 中国血液透析充分性临床实践指南. 中华医学杂志, 2015, 95(34): 2748-2753.
32. Leenen FH, Nwachuku CE, Black HR, et al. Clinical events in high-risk hypertensive patients randomly assigned to calcium channel blocker versus angiotensin-converting enzyme inhibitor in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension, 2006, 48(3): 374-384.
33. Agarwal R, Sinha AD, Pappas MK, et al. Hypertension in hemodialysis patients treated with atenolol or lisinopril: a randomized controlled trial. Nephrol Dial Transplant, 2014, 29(3): 672-681.
34. Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet, 2015, 386(10008): 2059-2068.
35. Lopes AA, Bragg-Gresham JL, Ramirez SP, et al. Prescription of antihypertensive agents to haemodialysis patients: time trends and associations with patient characteristics, country and survival in the DOPPS. Nephrol Dial Transplant, 2009, 24(9): 2809-2816.
36. Liu Y, Ma X, Zheng J, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials. BMC Nephrol, 2017, 18(1): 206.

West China Medical Journal

Interpretation of guidelines for hypertension in chronic kidney disease

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