高血压与肾病课件 (2).pptVIP

Epidemiology ofRenal Disease inHypertension Renal Disease in HypertensionEpidemiology Effects of hypertension on the kidney Interactions of hypertension and concomitant conditions on the kidney Age Atherosclerosis Diabetes mellitus Race Morbidity mortality associated with chronic renal disease Coronary artery disease Progression of chronic renal disease End Stage Renal Disease (ESRD) Hypertension as a consequence of ESRD Renal Disease in HypertensionA Historical Perspective Traube (Berlin, 1856) “High Blood Pressure Is Needed” Postulated that arterial pressure was elevated to overcome mechanical resistance against blood flow through thickened arteries. Believed that increased blood pressure was necessary for excretory efficiency of the kidney. Promoted these concepts which were unchallenged for almost 80 years. Page (Cleveland, 1934) “High Blood Pressure Is NOT Necessary” Developed renal clearance techniques that estimated renal blood flow in humans. Reduced elevated blood pressure without a fall in urea clearance. Demonstrated that early antihypertensive measures were not detrimental to renal function. Radical sympathectomy in essential malignant hypertension safely lowered arterial blood pressure without loss of renal function. Risk Factors for Progression of Renal Disease ESRD Due to Any CauseIn 332,544 Men Screened for MRFITAdjusted Relative Risk§ HTN Linked To Chronic Renal Disease Among 332,544 Men Screened for MRFIT Incidence Rates of Reported ESRD by Primary Diagnosis Primary Diagnoses for Patients Who Start Dialysis Persons Initiating Treatment for ESRD Related to Diabetes in the US Global Estimates and Projectionsfor Incidence of Diabetes Mellitus Odds Ratio For ESRD By RaceRacial differences in ESRD in the USA from 1990 to 1998 Effect of Hypertension on Mortality in Diabetic Pima IndiansAge-Adjusted Death Rates for Diabetic Nephropathy Risk of Ischemic Heart Disease Related to SBP and Microalbuminuria Microalbuminuria Compared To Tradi