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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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在慢性病中评估血压目标:系统性审查和元分析
Kazuhiro Tada1, Akira Fujiwara2, Naoki Sugano3
1Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. ktada@fukuoka-u.ac.jp.
概括
慢性病 (CKD) 患者的密集血压 (BP) 控制可能会降低死亡率和心血管风险. 这种方法并没有增加严重病事件的风险,包括末期病 (ESKD).
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 心脏病学 心脏病学
- 临床试验 临床试验
背景情况:
- 对于患有慢性病 (CKD) 的患者来说,最佳血压 (BP) 目标仍在争论中.
- 现有的研究缺乏关于CKD群体理想的BP管理策略的最终共识.
研究的目的:
- 系统地审查和元分析随机对照试验 (RCT),评估慢性病患者的密集与不那么密集的血压控制.
- 评估密集血压控制对死亡率,心血管事件和结局的影响.
主要方法:
- 系统性审查和RCT的元分析,比较密集的BP目标 (<130/80 mmHg) 与不那么密集的目标 (130-149/80-89 mmHg或通常的护理).
- 搜索了MEDLINE,Cochrane图书馆和Ichushi Web直到2024年6月,包括手动搜索.
- 分析了主要结果 (全因死亡率,心血管事件) 和次要结果 (脏事件,末期脏病[ESKD]).
主要成果:
- 在分析中包括了9个RCT.
- 强化血压控制显示了减少所有原因死亡率 (RR=0.81) 和心血管事件 (RR=0.89) 的趋势,尽管在统计学上并不显著.
- 在密集控制血压的情况下,没有观察到严重事件风险的显著增加 (50%的eGFR/GFR减少或ESKD进展).
结论:
- 针对<130/80 mmHg的强化血压控制可能有助于降低慢性病患者的死亡率和心血管事件.
- 这种密集的策略在功能方面似乎是安全的,不会增加严重事件或ESKD的风险.
- 进一步的研究可能会巩固在CKD管理中最佳BP目标的证据.
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