Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD
Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD
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DOI：
10.2215/cjn.04330418
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发表时间：
2019-05-07
影响因子：
9.8
通讯作者：
Agarwal, Rajiv
中科院分区：
文献类型：
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作者：
Sinha, Arjun A.;Agarwal, Rajiv
CKD在透析前和ESKD中是常见的，并且经常并发高血压。高血压作为该高危人群心血管疾病的主要可改变风险因素，CKD患者的高血压治疗非常重要。本文综述了主要抗高血压药物的作用机制和适应症，包括血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂、β-肾上腺素能阻滞剂、二氢吡啶类钙通道阻滞剂、噻嗪类利尿剂、袢利尿剂、盐皮质激素受体阻滞剂、直接血管扩张剂和中枢作用β-受体激动剂。最近的证据表明，肾上腺素能受体阻滞剂可能在透析患者中发挥更大作用，噻嗪类利尿剂可能在晚期CKD患者中发挥更大作用。最后，我们分享了透析前CKD患者和透析中ESKD患者的一般处方算法。
CKD is common and frequently complicated with hypertension both predialysis and in ESKD. As a major modifiable risk factor for cardiovascular disease in this high-risk population, treatment of hypertension in CKD is important. We review the mechanisms and indications for the major classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, -adrenergic blocking agents, dihydropyridine calcium channel blockers, thiazide diuretics, loop diuretics, mineralocorticoid receptor blockers, direct vasodilators, and centrally acting -agonists. Recent evidence suggests that -adrenergic blocking agents may have a greater role in patients on dialysis and that thiazide diuretics may have a greater role in patients with advanced CKD. We conclude with sharing our general prescribing algorithm for both patients with predialysis CKD and patients with ESKD on dialysis.