Preserving renal function in adults with hypertension and diabetes: A consensus approach
Preserving renal function in adults with hypertension and diabetes: A consensus approach
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DOI：
10.1053/ajkd.2000.16225
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发表时间：
2000-09-01
影响因子：
13.2
通讯作者：
Sowers, J
中科院分区：
文献类型：
--
作者：
Bakris, GL;Williams, M;Sowers, J
超过1100万美国人同时患有糖尿病和高血压——这些共病使人们极易遭受肾脏以及心血管（CV）损伤。高血压在很大程度上导致了糖尿病患者的心血管疾病发病率和死亡率。在美国，糖尿病是终末期肾病最常见的病因。此外，高血压和糖尿病在某些人群中尤为普遍，比如非裔美国人和美洲原住民。自1994年高血压与糖尿病工作组报告发布以来，大量临床试验数据证实了最初建议的将血压控制在130/85 mmHg以下的目标，以保护高血压和糖尿病患者的肾功能并减少心血管事件。然而，近期出现的数据支持更低的舒张压目标，即80 mmHg，以便在糖尿病肾病患者中最佳地保护肾功能和减少心血管事件。对临床试验的回顾表明，超过65%的糖尿病和高血压患者将需要两种或更多不同的抗高血压药物来达到新建议的130/80 mmHg的目标血压。本报告的目的是更新先前的建议，重点关注血压控制水平、蛋白尿减少以及实现这些目标的治疗方法。我们提供了一种基于证据的方法，整合了来自主要临床试验的数据，这些试验被设计为随机前瞻性长期研究，其主要终点是糖尿病肾病的进展或心血管事件的减少。本报告还涉及阻碍血压目标实现的社会经济和文化障碍。最后，报告讨论了解决医生和患者方面的文化障碍的方法，这些障碍干扰了更低血压目标的实现。（C）2000年，美国国家肾脏基金会版权所有
Over 11 million Americans have both diabetes and hypertension-comorbid diseases that strongly predispose people to both renal as well as cardiovascular (CV) injury. Hypertension substantially contributes to CV morbidity and mortality in people with diabetes. Diabetes is the most common cause of end-stage renal disease in the United States. Furthermore, hypertension and diabetes are particularly prevalent in certain populations, such as African-Americans and Native Americans. Since the 1994 Working Group Report on Hypertension and Diabetes, a large body of clinical trial data has affirmed the original blood pressure goal of less than 130/85 mmHg recommended to preserve renal function and reduce CV events in people with hypertension and diabetes. Data that are more recent have emerged, however, to support an even lower diastolic blood pressure goal, ie, 80 mmHg, in order to optimally preserve renal function and reduce CV events in people with diabetic nephropathy. A review of clinical trials indicates that more than 65% of people with diabetes and hypertension will require two or more different antihypertensive medications to achieve the new suggested target blood pressure of 130/80 mmHg. The purpose of this report is to update the previous recommendations with a focus on level of blood pressure control, proteinuria reduction, and therapeutic approaches to achieve these goals. We provide an evidence-based approach, integrating data from the major clinical trials that were designed as randomized prospective, long-term studies that had as a primary endpoint either progression of diabetic nephropathy or reduction in CV events. This report also addresses socioeconomic and cultural barriers that hinder achievement of blood pressure goals. Lastly, the report discusses approaches to resolve cultural barriers, both physician- and patient-derived, that interfere with achievement of lower blood pressure goals. (C) 2000 by the National Kidney Foundation, Inc.