Progression of chronic kidney disease: The role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition - A patient-level meta-analysis
Progression of chronic kidney disease: The role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition - A patient-level meta-analysis
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DOI：
10.7326/0003-4819-139-4-200308190-00006
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发表时间：
2003-08-19
影响因子：
39.2
通讯作者：
Levey, AS
中科院分区：
文献类型：
--
作者：
Jafar, TH;Stark, PC;Levey, AS
背景：血管紧张素转换酶(ACE)抑制剂降低血压和尿蛋白排泄，减缓慢性肾脏疾病的进展。目的：确定在使用和不使用ACE抑制剂的抗高血压治疗中，血压和尿蛋白排泄与慢性肾脏疾病进展风险最低相关的水平。资料来源：11项随机对照试验，比较使用和不使用ACE抑制剂的降压方案对以非糖尿病肾病为主的患者的疗效。资料选择：Medline数据库，1977年至1999年发表的英文研究。资料提炼：1860名非糖尿病患者的数据纳入患者水平荟萃分析。肾脏疾病的进展被定义为基线血肌酐水平增加一倍或出现肾功能衰竭。对22610例患者进行了多变量回归分析，以评估收缩压、舒张压和尿蛋白排泄量与肾脏疾病进展的关系。资料综合：平均随访时间为2.2年。记录了311名患者的肾脏疾病进展情况。收缩压在110-129毫米汞柱之间，尿蛋白排泄量低于2.0g/d与肾脏疾病进展的风险最低相关。调整血压和尿蛋白排泄量后，血管紧张素转换酶抑制剂仍然有益(相对风险，0.67[95%CI，0.53至0.84])。尿蛋白排泄量大于1.0g/d的患者，在较高的收缩压水平时，肾脏进展的风险增加(P
Background: Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure and urine protein excretion and slow the progression of chronic kidney disease.Purpose: To determine the levels of blood pressure and urine protein excretion associated with the lowest risk for progression of chronic kidney disease during anti hypertensive therapy with and without ACE inhibitors.Data Sources: 11 randomized, controlled trials comparing the efficacy of anti hypertensive regimens with or without ACE inhibitors for patients with predominantly nondiabetic kidney disease.Study Selection: MEDLINE database search for English-language studies published between 1977 and 1999.Data Extraction: Data on 1860 nondiabetic patients were pooled in a patient-level meta-analysis. Progression of kidney disease was defined as a doubling of baseline serum creatinine level or onset of kidney failure. Multivariable regression analysis was performed to assess the association of systolic and diastolic blood pressure and urine protein excretion with kidney disease progression at 22610 patient visits.Data Synthesis: Mean duration of follow-up was 2.2 years. Kidney disease progression was documented in 311 patients. Systolic blood pressure of 110 to 129 mm Hg and urine protein excretion less than 2.0 g/d were associated with the lowest risk for kidney disease progression. Angiotensin-converting enzyme inhibitors remained beneficial after adjustment for blood pressure and urine protein excretion (relative risk, 0.67 [95% CI, 0.53 to 0.84]). The increased risk for kidney progression at higher systolic blood pressure levels was greater in patients with urine protein excretion greater than 1.0 g/d (P