Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis
Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis
复制标题
DOI：
10.1503/cmaj.121468
复制
发表时间：
2013-08-06
影响因子：
14.6
通讯作者：
Perkovic, Vlado
中科院分区：
文献类型：
--
作者：
Lv, Jicheng;Ehteshami, Parya;Perkovic, Vlado
背景：最近的指南建议降低慢性肾脏病患者的目标血压，尽管这一建议的证据强度尚不确定。我们试图评估的肾脏和心血管的影响，密集的血压降低慢性kidneydisease.Methods的人：我们进行了系统的回顾和荟萃分析，1950年和2011年7月之间发表的所有相关报告中确定的搜索MEDLINE，Embase和科克伦图书馆。我们纳入了随机试验，这些试验将慢性肾脏疾病患者分配到不同的目标血压水平，并报告了肾衰竭或心血管事件。两个审查独立地确定相关的文章和提取data.Results：我们确定了11项试验提供的信息9287例慢性肾脏疾病和1264肾衰竭事件（定义为一个复合物的血清肌酐水平增加一倍，肾小球滤过率下降50%，或终末期肾病）。与标准方案相比，更强化的降压策略降低了复合结局（风险比[HR] 0.82，95%置信区间[CI] 0.68-0.98）和终末期肾病（HR 0.79，95% CI 0.67-0.93）的风险。亚组分析显示，基线蛋白尿（p = 0.006）和试验质量标志物的影响。强化降压可降低肾衰竭的风险（HR 0.73，95% CI 0.62-0.86），但在基线时无蛋白尿的患者中则不然（HR 1.12，95% CI 0.67-1.87）。对心血管事件或死亡的风险没有明显影响。解释：强化降压似乎对慢性肾脏疾病患者，特别是蛋白尿患者的肾衰竭事件提供保护。需要更多的数据来确定这种策略在无蛋白尿患者中的效果。
Background:Recent guidelines suggest lowering the target blood pressure for patients with chronic kidney disease, although the strength of evidence for this suggestion has been uncertain. We sought to assess the renal and cardiovascular effects of intensive blood pressure lowering in people with chronic kidney disease.Methods:We performed a systematic review and meta-analysis of all relevant reports published between 1950 and July 2011 identified in a search of MEDLINE, Embase and the Cochrane Library. We included randomized trials that assigned patients with chronic kidney disease to different target blood pressure levels and reported kidney failure or cardiovascular events. Two reviewers independently identified relevant articles and extracted data.Results:We identified 11 trials providing information on 9287 patients with chronic kidney disease and 1264 kidney failure events (defined as either a composite of doubling of serum creatinine level and 50% decline in glomerular filtration rate, or end-stage kidney disease). Compared with standard regimens, a more intensive blood pressure-lowering strategy reduced the risk of the composite outcome (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.68-0.98) and end-stage kidney disease (HR 0.79, 95% CI 0.67-0.93). Subgroup analysis showed effect modification by baseline proteinuria (p = 0.006) and markers of trial quality. Intensive blood pressure lowering reduced the risk of kidney failure (HR 0.73, 95% CI 0.62-0.86), but not in patients without proteinuria at baseline (HR 1.12, 95% CI 0.67-1.87). There was no clear effect on the risk of cardiovascular events or death.Interpretation:Intensive blood pressure lowering appears to provide protection against kidney failure events in patients with chronic kidney disease, particularly among those with proteinuria. More data are required to determine the effects of such a strategy among patients without proteinuria.