| 摘要: |
| ［摘要］ 近年来在国际顶刊发表的多项大型循证医学研究证实，强化降压治疗可以有效降低高血压患者的死亡率，减少心血管事件，但强化降压对肾脏结局的影响存在争议。研究显示，强化降压短期内可能增加肾脏不良事件风险，而长期观察则具有延缓慢性肾脏病（CKD）进展的作用。强化降压对合并蛋白尿、CKD分期增高患者的肾脏保护效应更显著，提示不同临床特征的CKD患者可能从强化降压策略中获得差异化的肾脏获益。降压治疗不仅要单次达标，而且要长期达标。一直以来我国CKD患者血压达标率低，高血压导致肾病进展的问题未得到有效控制。该文通过阐述降压治疗对CKD患者的综合获益，根据最新临床研究结果和国际指南，强调不仅要提高CKD患者高血压的降压达标率，还要向强化降压和长期达标的目标努力。 |
| 关键词: 高血压 强化降压 慢性肾脏病 达标时间 |
| DOI：10.3969/j.issn.1674-3806.2025.12.01 |
| 分类号:R 692 |
| 基金项目:国家重点研发计划项目（编号：2024YFC3607400） |
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| Hypertension management in chronic kidney disease: adherence to intensive blood pressure control and long-term time in target range |
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ZHOU Shuwen1,2,3, CAI Guangyan2
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1.Chinese PLA Medical School, Beijing 100853, China; 2.Department of Nephrology, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; 3.School of Medicine, Nankai University, Tianjin 300071, China
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| Abstract: |
| ［Abstract］ In recent years, several large-scale evidence-based medical researches published in top international journals have confirmed that intensive blood pressure control can effectively decrease the mortality of patients with hypertension and reduce their cardiovascular events. However, the impact of intensive blood pressure control on renal outcomes is controversial. Researches have shown that intensive blood pressure control may increase the risk of renal adverse events in the short term, but long-term observations have found that intensive blood pressure control has the effect of delaying the progression of nephropathy in patients with chronic kidney disease(CKD). Intensive blood pressure control has a more significant protective effect on the kidneys of CKD patients complicated with proteinuria and advanced CKD stages, suggesting that CKD patients with different clinical characteristics may obtain differential renal benefits from intensive blood pressure control strategies. Antihypertensive treatment should aim not only at achieving single-time target goal but also at maintaining long-term time in target range. For a long time, the rate of achieving blood pressure targets among CKD patients in China has been low, and the problem of hypertension resulting in the progression of kidney disease has not been effectively controlled. This paper elaborates on the comprehensive benefits of antihypertensive treatment for CKD patients. Based on the latest clinical research results and international guidelines, it emphasizes that efforts should not only be made to increase the rate of achieving blood pressure targets among CKD patients, but also to strive for intensive blood pressure control and achieving long-term time in target range. |
| Key words: Hypertension Intensive blood pressure control Chronic kidney disease(CKD) Time in target range |
