老年原发性高血压肾损害56例临床分析

目的：分析原发性高血压病合并肾脏损害与年龄的关系。方法：入选56例原发性高血压合并肾脏损害患者被分为老年组、青年组，进行随机对照分析。结果：老年原发性高血压的肾脏损害甚于青年组（P〈0．01）。老年组的病程与血肌酐含量呈正相关（r=1．320，P〈0．01）。结论：对原发性高血压患者应积极治疗，以延缓肾功能损害，尤其是老年人。     

老年人肾脏损害的营养因素

随增龄肾功能不全有增多趋势。研究表明,青、中年期由于饮食习惯和生活方式变化,可诱发高血压、动脉硬化、糖尿病、感染等疾病,此外尚有药物和过量摄入蛋白质等因素均可使青、中年人肾功能减退,及至老年期可发展为肾功能不全。本文着重讨论了这些因素对老年肾脏损害的机理。     

硝苯地平缓释片治疗慢性肾功能不全合并高血压患者的疗效

<正>慢性肾功能不全又称慢性肾衰,是各种原因引起的慢性进行性肾实质损害而造成水与电解质、酸碱平衡紊乱出现以全身各系统受累为主要表现的临床综合征。心血管疾病是慢性肾衰患者最严重的并发症和首要死亡原因;其中,高血压最为常见〔1〕。高血压与慢性肾衰关系密切,二者互为独立危险因素,积极防治慢性肾衰合并高血压具有十分重要的临床意义。本文就我院将硝苯地平缓释片用于慢性肾功能不全合并高血压患者的效果进行观察。     

原发性高血压与肾功能不全

(本文是《抗高血压治疗中的肾功能》的短评)。Madhavan等在大系列高血压病人中报告了令很多临床医生不可思议的肌酐(Cr)研究结果:除重度和急进性高血压外,没有肾脏本身疾病的高血压病人发生进行性肾功能衰竭是罕见的。 临床实践中高血压相关的肾功能衰竭不常见,高血压肾脏损害的特征主要是在统计     

高血压伴肾功能不全57例临床研究

该文探讨了高血压合并肾功能不全病人的降压效果及血压不达标的影响因素。方法：收集2003-03—2005—02住院的高血压合并肾功能不全的57例病人（男36例，女21例），年龄46～82岁，选取同期住院的不伴肾功能不全的高血压病人59例作为对照（男32例，女27例），年龄45～82岁，比较2组病人降压药应用及血压达标情况。分析高血压合并肾功能不全病人的肾功能不全形成原因及血压不达标的影响因素。结果：（1）肾功能不全的病因构成比：高血压肾病占59．6％，糖尿病肾病占35．1％，其他5．3％。（2）高血压伴肾功能不全组和单纯高血压组的血压达标率分别为70．2％和91．5％（P〈0．01）。     

老年人肾功能不全与心力衰竭

随着年龄的增长,人群中心力衰竭(心衰)的发病率也在增加;>65岁的人群中可达6%~10%。心衰主要是由心脏本身病变引发的,但是也可由一些相关的疾病引起;肾脏疾病就是其中之一。心脏与肾脏有时有一些共同的病理基础(如高血压、动脉粥样硬化、糖尿病等),可以引起各自的损害与功能不全,但是心功能与肾功能可以相互影响,心功能不全时可以引起肾脏损害及功能不全,肾功能是心功能不全的预测因子。蛋白尿和肾小球滤过率(glo-merular filtration rate,GFR)下降是心血管疾病进展的独立危险因素[1]。有作者报道GFR每下降1ml/(min.1.73m2)死亡率增加1%[…     

科素亚治疗高血压伴肾功能不全病人的疗效

血管紧张素(Angiotensin)在高血压病变发生、发展中有着重要的作用,且在导致靶器官损害中扮演重要角色[1].有研究发现,高血压病人尿中白蛋白增加是导致心脑血管疾病、死亡等的独立危险因素[2].在降压治疗过程中,保护肾脏靶器官的观点已被广泛接受.血管紧张素受体Ⅱ拮抗剂(ATⅡ)是一种应用广泛的抗高血压药物.本文观察ATⅡ类药物科素亚对高血压合并肾功能不全病人的治疗.     

卡维地洛与卡托普利联合治疗慢性心肾联合损害

心肾联合损害是指慢性心力衰竭（CHF）和慢性肾功能不全（CRF）共存，在老年人群中发病率高。心脏和肾脏的损害相互影响，互为因果，加速心。肾功能衰竭。近年多个大型研究证实了卡维地洛的心脏保护作用，小规模临床及实验研究也肯定了对肾脏功能的正面影响，一些研究也证实了卡维地洛改善CHF合并CRF患者的心肾功能的作用。本研究设计了单盲，随机，对照试验，旨在评价卡维地洛与卡托普利联用在治疗慢性心肾联合损害的疗效和安全性。     

高血压肾脏损害类型和机制研究进展

随着高血压患病率的直线上升,高血压肾脏损害已成为糖尿病外造成终末期肾病(end-stage renal disease,ESRD)的最主要原因.近年来我国因高血压肾脏损害而进入慢性肾功能不全的患者人数呈逐年增多的趋势.高血压肾损害可长时间没有任何症状,而一旦出现肌酐水平增高、微量白蛋白尿等肾损害临床特征时,发生心血管事件、ESRD和猝死的危险明显增高.而早期发现肾损害并进行合理治疗,可延缓肾病进展.因此研究高血压肾损害对减少心血管事件和ESRD有重要意义.     

重度急性一氧化碳中毒合并急性肾功能不全21例分析

重度一氧化碳中毒以中枢神经系统损害和心肌损害为主要临床表现,合并肾功能不全的报道不多。我院ICU治疗重度一氧化碳中毒引起的急性肾功能不全21例,现报道如下。     

Effects of calcium antagonist, benidipine, on the progression of chronic renal failure in the elderly: a 1-year follow-up

The number of patients who needs for dialysis therapy is increasing rapidly among the older population. Although control of hypertension can delay or arrest the progression of renal failure, there are lacking of studies about antihypertensive treatment of chronic renal failure in the elderly. We have studied the effects of treating hypertension with a calcium antagonist, benidipine, on renal function and blood pressure in 58 patients (mean age: 71 +/- 9) with hypertension and chronic renal insufficiency (the levels of creatinine ranging from 1.5 to 4.0 mg/dl). The underlying disease included glomerulopathies (in 33), diabetic nephropathy (in 15), and other causes (in 10). Forty two patients who had been treated with other antihypertensive drugs other than angiotensin converting enzyme (ACE) inhibitors, antihypertensive drugs were withdrawn 2 weeks before the entry. At the entry, patients should have sitting systolic blood pressure (SBP) of above 160 mmHg and diastolic blood pressure (DBP) of above 90 mmHg. In total, both SBP and DBP decreased from 169/95+/-12.5/8.9 to 148/81+/-16.1/8.0 mmHg (p<0.001) with remaining the serum creatinine levels from 2.2+/-0.8 vs 2.4+/-1.3 mg/dl (P>0.05). Retrospective analysis revealed that in 4 of 4 patients treated with benidipine and 2 of 3 patients with benidipine and ACE inhibitors with systolic blood pressure more than 160 mmHg at the end of the study, the levels of serum creatinine increased from 2.5+/-0.3 to 2.8+/-0.4 with significance (P<0.05). If systolic blood pressure was reduced less than 159 mmHg, 38 of 48 patients did not show any deterioration of renal function. Compared to the significance of SBP in preserving renal function, DBP did not associate with the changes in renal function. No patients died during the study. One patient had transient ischemic attack and one patient had stroke in benidipine treated group. One patient had angina pectoris in benidipine-ACE inhibitors treated group. The results of our trial seem to give some support for the idea that long-acting calcium antagonists such as benidipine are renoprotective through reduction of SBP in the elderly people with hypertension and chronic renal insufficiency. However, if systolic blood pressure was not reduced below 160 mmHg throughout a year, the substantial declines in renal function would be expected.     

Prognosis in therapy-resistant hypertension

Abstract. Objectives. To study the prognosis in therapy-resistant hypertension (RH). Design. Patients with RH and age- and sex-matched responding hypertensives, were followed-up for a period of 7 years. Setting. All subjects were outpatients at a secondary referral centre for hypertension. Subjects. (i) Age ≤ 65 years; (ii) no prior diagnosis of secondary hypertension; (iii) on antihypertensive triple-drug therapy of optimal dosage; (iv) diastolic blood pressure remaining 5 mmHg above their (age-related) target pressure; (v) no history of renal failure, heart failure, stroke or myocardial infarction; and (vi) no record of noncompliance. A total of 800 patients were screened. Thirty-six were finally included. For each study patient, two control patients were randomly selected. Interventions. Continuous efforts to optimize blood pressure control were made in all patients. Main outcome measures. Transient ischaemic attack or stroke, myocardial infarction, congestive heart failure, renal failure, and death. Development of non-insulin-dependent diabetes mellitus (NIDDM). Results. At the end of the follow-up period, RH had a casual functional blood pressure 21/6 mmHg higher than the control hypertensives. RH exhibited an increased incidence of stroke (P < 0.05), renal insufficiency (P < 0.05) and NIDDM (P < 0.05). RH patients had an increased risk of suffering an event during the 7 years [odds ratio (OR) 2.71; P < 0.05]. Conclusions. Resistance to antihypertensive therapy may persist even when therapy is aggressively applied in compliant patients. RH is associated to an increased risk of stroke and of target organ damage, foremost renal insufficiency. The apparent association between RH, obesity and NIDDM may imply that hyperinsulinaemia is involved in therapy resistance.     

Arterielle Hypertonie als Progressionsfaktor der chronischen Niereninsuffizienz

Arterial hypertension is the major factor for progression in chronic renal insufficiency. The kidneys may be the origin of hypertension as well as the target organs. Microalbuminuria is an early and reliable marker for renal damage. Renal insufficiency as well as albuminuria are separate risk factors for severe cardiovascular events. Therapeutic approaches for delaying progression of renal insufficiency therefore imply lowering or delaying proteinuria besides lowering hypertension. Convincing data for an advantage of a target blood pressure lower than 130/80?mmHg in patients with proteinuria or diabetes are currently lacking.     

Cardiovascular therapy in patients with renal insufficiency

Chronic renal failure and arterial hypertension run in parallel. New goal blood pressure levels have been established in 130/85 mmHg and 125/75 mmHg depending on the level of proteinuria being below or above 1 g/day.New and lower threshold BP (>130/85 mmHg) to initiate pharmacologic therapy are required in the presence of renal failure in order to facilitate the strict BP control that is required.Renal insufficiency is accompanied since its initial stages by a marked increase in cardiovascular risk and serum creatinine, its estimated clearance and the presence of proteinuria are very powerful predictors of a bad cardiovascular outcome. Hence, the need to consider that both renal and cardiovascular protection are obtained with such a strict BP control which, otherwise seems to require blockade of angiotensin II effects when proteinuria above 1g/day is present.Prevention of renal failure related to elevated blood pressure requires of strict blood pressure control, usually obtained with combination of two or more antihypertensive agents, one of them capable of blocking angiotensin II. Besides this, strict control of associated cardiovascular risk factors is also required.     

Effect of telmisartan on blood pressure control and kidney function in hypertensive, proteinuric patients with chronic kidney disease

OBJECTIVES: To assess the antihypertensive and antiproteinuric efficacy and safety of the angiotensin II type 1 receptor blocker telmisartan in patients with hypertension and chronic kidney disease. METHODS: A multicenter, prospective trial was performed in adults with hypertension [systolic blood pressure (SBP)/diastolic blood pressure (DBP) >130/85 mmHg), chronic renal insufficiency (serum creatinine <4.0 mg/dl), and proteinuria (>1 g/24 h). In addition to existing antihypertensive therapy, the nature and doses of which remained unchanged throughout the study, patients received once-daily telmisartan 40 mg for the first 3 months followed by forced titration to telmisartan 80 mg for the subsequent 3 months to achieve a target SBP/DBP of <130/85 mmHg. The rationale for using telmisartan was its long half-life efficacy, greater antihypertensive effect compared with valsartan or losartan, and newly discovered potential antidiabetic effect. RESULTS: The study was conducted in 92 patients (45 men, 47 women), of whom 60 had diabetes mellitus (54 patients with type 2 disease). Five patients discontinued prematurely: two because of hyperkalemia, two because of protocol violation, and one because of lack of efficacy. After 6 months' telmisartan treatment, office trough seated SBP was reduced by 19.6 mmHg (P<0.001) from 154.9+/-14.6 mmHg and DBP by 11.8 mmHg (P<0.001) from 91.7+/-8.1 mmHg. Seated trough SBP/DBP of <130/85 mmHg was achieved at 6 months in 34.8% of patients. Ambulatory blood pressure monitoring also demonstrated significant reductions in mean daytime SBP of 10.9 mmHg (P=0.01), night-time SBP of 12.1 mmHg (P=0.05), daytime DBP of 3.1 mmHg (P=0.05), and night-time DBP of 6.5 mmHg (P=0.05). Proteinuria decreased significantly from 3.6+/-3.4 to 2.8+/-2.8 g/24 h (P=0.01). A decrease in proteinuria depended significantly on a decrease in SBP at the end of the study (P=0.044). Each decrease in SBP of about 10 mmHg led to a decrease in proteinuria of about 0.79 g/24 h (95% CI 0.02-1.56 g/24 h). Serum creatinine increased from 1.96+/-0.79 to 2.08+/-0.89 mg/dl (P=0.01), whereas creatinine clearance did not change significantly. CONCLUSIONS: Telmisartan effectively and safely reduced blood pressure and brought about regression of proteinuria in diabetic and nondiabetic, hypertensive, proteinuric patients with chronic kidney disease, even in those with mild-to-moderate chronic renal failure.     

老年高血压病患者治疗后血压水平与认知功能的相关性

目的:探讨长期坚持降压治疗的老年高血压病患者血压水平与认知功能的关系。方法:军队离退休老年高血压患者105例,按MMSE评分分为认知障碍组和正常组,比较两组患者治疗后血压水平及血糖、血脂、血同型半胱氨酸水平,并比较不同收缩压及舒张压水平下患者MMSE评分。结果:认知功能障碍组高血压病程、同型半胱氨酸水平明显高于认知功能正常组(P<0.01)。将高血压病程作为协变量,多因素协方差分析显示,调整高血压病程的影响后,收缩压130~149 mmHg组在MMSE总分、定向力、记忆力、注意力、回忆力、语言能力得分高于111~129 mmHg组和150~160 mmHg组。其中,130~149 mmHg组与111~129 mmHg组比较,定向力、记忆力、注意力、回忆力、语言能力及MMSE总分差异有统计学意义(P<0.01);与150~160 mmHg组比较定向力差异有统计学意义(P<0.01)。不同舒张压水平的患者认知功能比较差异无统计学意义。结论:在老年高血压患者的降压治疗中,目标收缩压水平长期控制在130~149 mmHg对认知功能可能有保护作用。     

Resistant hypertension: is renal denervation the current treatment of choice?

Background: Resistant hypertension is simply defined as failure to control blood pressure <140/90?mmHg in an adherent non-diabetic patient with normal kidney function despite the use of optimal doses of three antihypertensive agents, including a diuretic. Also, control of blood pressure in any adherent patient with more than four antihypertensive agents defines resistant hypertension. In a patient with diabetes or chronic kidney disease, the goal blood pressure is <130/80?mmHg. One of the most important pathophysiological mechanisms of resistant hypertension is overactivity of the sympathetic nervous system (SNS). In selected patients with resistant hypertension, renal denervation has been shown to control blood pressure by suppressing SNS overactivity. Summary: This review summarizes the results of the studies of renal denervation for resistant hypertension and suggests the use of this procedure in several other conditions that are associated with SNS overactivity. Key message: Renal denervation seems to control blood pressure in patients with resistant hypertension.     

Update in pharmacologic treatment of hypertension.

Initial pharmacologic therapy for hypertension is low-dose thiazide diuretics, beta-blockers, and ACE inhibitors. Increasing data have confirmed that ACE inhibitors have specific benefit in patients with diabetes, atherosclerosis, left ventricular dysfunction, and renal insufficiency. CCBs are alternative agents for ISH in the elderly and appear to decrease stroke with perhaps less protection against progression of renal insufficiency and proteinuria, CAD mortality and new onset heart failure versus other initial agents, especially ACE inhibitors. ARBs are well tolerated and effective blood pressure lowering agents but have not been confirmed as effective as ACE inhibitors for reducing renal progression, clinical events, or mortality from heart failure. Effective pharmacologic antihypertensive therapy may avoid disabling and undetected cerebrovascular disease, cognitive dysfunction, and disturbing symptoms of elevated blood pressure. Vasopeptidase inhibitor, such as omapatrilat, and endothelin-1 antagonist, such as bosentan, may become future agents approved for the reduction of morbidity and mortality with hypertension. The ALLHAT trial continues to examine the potential benefits and harms of amlodipine versus chlorthalidone and lisinopril in a diverse high-risk population. Based on ALLHAT data, however, doxazosin is no longer an acceptable initial pharmacological agent. Intensive pharmacologic treatment with blood pressure lowering to less than 130/85 mm Hg is recommended with diabetes, renal insufficiency, and heart failure with additional goal of less than 125/75 mm Hg with renal failure and proteinuria greater than 1 g/24 h, based on multiple outcome studies.     

Antihypertensive treatment in patients with type-2 diabetes mellitus: what guidance from recent controlled randomized trials?

BACKGROUND: Patients with type-2 diabetes have a high prevalence of hypertension and show an elevated incidence of cardiovascular events and nephropathy. OBJECTIVES: Recent randomized trials of antihypertensive therapy providing information about cardiovascular and renal risk in diabetes, blood pressure goals and best suitable drugs were reviewed. FINDINGS: Evidence that association of type-2 diabetes with hypertension markedly increases cardiovascular and renal risk is incontrovertible: even blood pressure values in the high-normal range represent a more relevant risk than in non-diabetics. More versus less intensive blood pressure lowering or active versus placebo treatment can significantly prevent cardiovascular and renal events, with a particularly consistent reduction of proteinuria and microalbuminuria. Although several of the trials showing significant reduction of cardiovascular or renal risk achieved diastolic blood pressure (DBP) between 75 and 82 mmHg, systolic blood pressure (SBP) 140 mmHg was never achieved in trials showing cardiovascular benefits and SBP 130 mmHg was only achieved in two trials in normotensive subjects showing proteinuria reduction. The recommendation given by all major guidelines to lower SBP 130 mmHg appears to be difficult to comply with. Evidence of the superiority or inferiority of different drug classes (angiotensin-converting enzyme inhibitors, calcium antagonists, diuretics and beta-blockers) is rather vague, especially for cardiovascular protection. As to angiotensin-receptor antagonists, losartan has shown significant cardiovascular protection over a beta-blocker, and irbesartan, although not showing cardiovascular benefits over a calcium antagonist, was significantly better in retarding renal dysfunction and failure. CONCLUSIONS: In most trials on hypertensive diabetics, the large majority of patients were on two, three and even four-drug therapy. Therefore, it appears reasonable that all effective and well tolerated antihypertensive agents can be used in association to achieve DBP 80 mmHg and, whenever possible, SBP 130 or 135 mmHg, with the regular inclusion of an angiotensin-receptor antagonist for its proven renoprotective action. Hopefully, better guidance will be provided by further trials.     

运动性高血压与动脉硬化和早期肾损害的相关性

目的 探讨原发性高血压患者中运动性高血压与动脉硬化及早期肾损害的关系。方法 选择原发性高血压患者105例，根据Bruce方案行次极量跑台运动负荷试验，依据次极量运动时收缩压（SBP）分为运动性高血压组（次极量运动时SBP≥200 mmHg,H组）和运动血压正常组（次极量运动时SBP<200 mmHg,N组），两组分别为46例和59例，均行血脂、肾功能、血糖、高敏C-反应蛋白（hs-CRP）、踝臂脉搏波传导速度（baPWV）、颈动脉内膜中层厚度（IMT）及尿微量白蛋白/肌酐（UACR）的检测，baPWV、IMT和UACR分别作为反映动脉硬化和早期肾损害的指标。结果 与N组比较，H组的BMI(P<0.01)、高血压家族史（P<0.05）、吸烟史（P<0.05）、LDLC(P<0.01)、hs-CRP(P<0.05)、baPWV(P<0.01)、IMT(P<0.05)与UACR(P<0.05)均显著升高；与N组比较，H组静息SBP升高（P<0.05），次极量运动时SBP、次极量运动时PP、运动后6 min SBP、运动后6 min ...