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慢性病中的血压目标:仍然没有共识
Bethany Lucas1,2, Maarten W Taal1,2
1Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham.
Current opinion in nephrology and hypertension
|September 27, 2023
概括
控制高血压是减缓慢性病 (CKD) 和减少心血管事件 (CVE) 的关键. 虽然降低血压 (BP) 的目标通常是有益的,但最佳的BP目标仍在争论中,需要个性化的方法.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 心脏病学 心脏病学
- 高血压管理 高血压管理
背景情况:
- 有效的高血压管理对于减缓慢性病 (CKD) 进展和减轻心血管疾病 (CVE) 风险至关重要.
- 根据基准试验,历史指南建议蛋白尿症患者的血压 (BP) 目标为<130/80 mmHg.
- 关于最佳BP目标,特别是根据新的证据和不断变化的临床指南,目前仍在进行辩论.
研究的目的:
- 在慢性病 (CKD) 的背景下,审查支持不同血压 (BP) 目标的证据.
- 讨论围绕CKD管理最佳BP目标的争议.
- 建议在患有CKD的患者中改善血压控制的策略.
主要方法:
- 对里程碑式的临床试验的审查和关于CKD的BP目标的更新指南.
- 关于不同BP目标对CKD进展和CVE风险的影响的证据分析.
- 考虑从缩血压干预试验 (SPRINT) 的发现.
主要成果:
- 较低的血压目标与慢慢的CKD进展有关,特别是在具有显著蛋白尿症的患者中.
- 斯普林特试验表明,在静脉血压目标<120 mmHg时,CVE风险降低,但对CKD进展和潜在的脏不良事件没有显著影响.
- 2021年病:改善全球结果 (KDIGO) 准则建议静脉压<120 mmHg,尽管所有更新的准则之间缺乏共识.
结论:
- 标准化血压测量对于准确的评估和管理至关重要.
- 建议采用个性化,共享的决策方法来设定BP目标和管理慢性脏病的高血压.
- 个性化策略对于优化血压控制和CKD患者的结果至关重要.
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