长期有效控制血压改善高危高血压患者的肾功能

Long-Term Intensive Blood Pressure Control Improves Renal Function in High Risk Hypertensive Patients

目的对《1999WHO/ISH高血压治疗指南》(《指南》)危险分层为高危和极高危组的患者单用或联合使用《指南》推荐的一线降压药,以血压<140/90mmHg作为目标血压,观察长期有效控制血压对高危高血压患者肾功能的影响。方法患者763例确定危险分层入选后,随机进入目标治疗组(n=382)和对照组(n=381)。目标治疗组在高血压专科门诊定期随访,按5步法治疗方案,直到达到或接近目标血压为止。对照组在普通门诊治疗。测定基线和治疗后的血清肌酐浓度并计算肾小球滤过率。结果两组患者的基线特征无明显差异。在平均4.4年随访期间,目标治疗组平均收缩压/舒张压为(133.8±6.6)/(79.7±5.5)mmHg,明显低于对照组[(151.7±12.7)/(87.7±8.0)mmHg,P<0.01]。尽管两组治疗强度不同,但两组间使用各类抗高血压药物的比例相似。共有526例患者复查血清肌酐1次以上。目标治疗组(n=304)血清肌酐由(90.9±29.1)降至(87.0±26.1)μmol/L,下降4.5%(P=0.006);对照组(n=222)则由(91.6±30.1)增至(96.4±46.4)μmol/L,增加5.2%(P=0.074),两组间治疗后比较,差异有非常显著意义(P<0.01)。目标治疗组血清肌酐清除率由(67.5±21.9)升至(70.0±22.3)mL/(min.1.73m2),升高4.5%(P=0.019);对照组则无明显变化[(66.9±24.2)vs(67.3±27.6)mL/(min.1.73m2),P=0.737]。结论与一般治疗相比,长期严格控制血压能降低高危高血压患者的血清肌酐,并提高血清肌酐清除率。

Objective We investigated the effect of long-term intensive blood pressure（BP） control （〈140/ 90 mm Hg） versus conventional antihypertensive therapy on serum creatinine and calculated creatinine clearance in high risk hypertensive patients. Methods We measured serum creatinine and calculated creatinine clearance at baseline and at least once during follow-up for 4.4 years in 526 randomized patients. Of them, 304 were allocated intensive BP control and 222 conventional therapy. Results At baseline clinical characteristics of the participants in the 2 groups were similar. During a mean follow-up of 4.4 years, systolic/diastolic BPs （x±s） decreased to （133.8±6.6）/（79.7±5.5） mm Hg in the intensive BP control group and （151.7±12.7）/（87.7±8. 0） mm Hg in the routine therapy group. Serum creatinine decreased from （90. 9 ± 29. 1） at baseline to （87. 0 ± 26. 1）ttmol/L at last measurement by 4.5% （P=0. 006） in the intensive BP control group, but increased from （91.6±30. 1） to （96. 4±46.4）μmol/L by 5.2% （P=0. 074） in the conventional therapy group. The difference between 2 groups was significant （P 〈 0. 01 ）. The calculated creatinine clearance increased from （67. 5 ± 21.9 ） mL/（min·1.73 m^2） at baseline to （70. 0±22.3）mL/（min·1.73 m^2） at last measurement by 4.5%（P=0. 019） in the intensive BP control group, but no significant changes in the conventional therapy group [66.9 ± 24.2 vs 67.3± 27.6 mL/（min·1.73 m^2） , P = 0. 737]. Conclusion Our study demonstrated that long-term intensive BP control decreased serum creatinine and increased the calculated creatinine clearance in high risk hypertensive patients.