慢性肾病患者的血压目标:在循证医学时代我们站在哪里?

Q4 Medicine Open Hypertension Journal Pub Date : 2020-01-01 DOI:10.15713/ins.johtn.0212
S. Nagaraju, S. Shenoy
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摘要

在过去十年中,BP测量技术也得到了很多重视。摘要慢性肾脏疾病(CKD)在全球范围内非常普遍,并且与心血管疾病(CVD)密切相关。高血压影响绝大多数CKD患者,并增加心血管疾病、终末期肾病和死亡率的风险。在临床实践中,控制CKD患者的高血压对于减缓CKD的进展以及降低CVD的风险非常重要。在过去的10年里,有三个主要的指南处理了CKD患者的血压阈值和降压药物治疗的目标:2012肾脏疾病:改善CKD患者血压管理的全球结果临床实践指南;2017年美国心脏病学会/美国心脏协会2017年成人高血压预防、检测、评估和管理指南;以及2018年欧洲心脏病学会和欧洲高血压学会动脉高血压管理指南。这些指南并没有就CKD患者的最佳血压目标达成共识,并且对血压目标有不同的建议。这可能会让执业医生和患者陷入两难境地。因此,有必要了解用于创建这些指南的现有证据,以提供个性化管理并实现CKD的血压目标。
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Target Blood Pressure Goals in Patients with Chronic Kidney Disease: Where Do We Stand in this Era of Evidence based Medicine?
There is also a lot of emphasis in the last decade about BP measurement techniques. BP measurement by automated BP instruments or Abstract Chronic kidney disease (CKD) is highly prevalent globally and is strongly associated with cardiovascular disease (CVD). Hypertension affects the vast majority of patients with CKD and increases the risk of CVD, end-stage kidney disease, and mortality. Control of hypertension in CKD is very important in our clinical practice to slow the progression of CKD as well as to reduce CVD risk. Over the past 10 years, three major guidelines have dealt with blood pressure (BP) thresholds and targets for antihypertensive drug therapy in CKD patients: The 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for the management of BP in CKD; the 2017 American College of Cardiology/American Heart Association 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High BP in Adults; and the 2018 European Society of Cardiology and the European Society of Hypertension guidelines for the Management of arterial hypertension. These guidelines do not offer a consensus on optimal BP targets and have varying recommendations for BP goals in patients with CKD. It may leave practicing physicians and patients in a dilemma. Therefore, it is necessary to understand the existing evidence used to create these guidelines to deliver personalized management and achieve BP targets in CKD.
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Open Hypertension Journal
Open Hypertension Journal Medicine-Cardiology and Cardiovascular Medicine
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