【高血压英文ppt课件】肾性高血压 Hypertension in Nephrology.pptVIP

Steps every clinician should take to reduce the incidence and/or progression of CKD Aggressive BP reduction Use of agents that interfere with the RAAS Steps to Reduce Renal Disease BP control, GFR decline and proteinuria Intense BP control An initial reduction in proteinuria of 1.0 g/d ? slower mean decrease in GFR by 0.92 ± 0.31 mL/min·y, GFR 25-55 by 1.32 ± 0.46 mL/min·y, GFR 15-24 Progression of CKD and BP Continued ramipril Switched to ramipril 2 Ruggenenti et al. Lancet 1998;352:1252-1256. REIN follow-up trial chronic nephropathy and proteinuria3g/day 25 30 35 40 45 Core study Follow-up trial GFR decline (mL/min/1.73m /month) -0.44ml/min per month -0.10ml/min per month -0.81ml/min per month -0.14ml/min per month AASK: ACEI vs CCB in Hypertensive Renal Disease Agodoa LY et al. JAMA. 2001;285:2719–2728. GFR Event, ESRD, or Death 25 20 15 10 5 0 0 3 12 24 36 Amlodipine Ramipril Cumulative Incidence, % Months P = 0.005 CCB arm terminated prematurely because ACEI and beta blocker demonstrated clear superiority Cardiovascular mortality Non-cardiovascular mortality Hans L. Hillege, et al., Circulation, 2002, 106:1777 End-organ damage and mortality in general population The Effect of Angiotensin-Converting Enzyme Inhibition on Diabetic Nephropathy 409 Type I diabetics ages 18-49 with nephropathy (U protein500 mg and S Cr 2.5) Prospective, double-blinded multicenter (30) trial randomized to captopril vs. placebo for 3 years Lewis EJ et al , New Engl J Med 329:1456-62, 1993 ACE Inhibition and Type I DM Nephropathy Lewis EJ et al, New Engl J Med 329:1456, 1993 3) These effects were independent of effects on blood pressure. If S Cr 1.5 mg/dl: Captopril reduced doubling of S Cr by 48% over 4 years. Captopril reduced ESRD(dialysis or transplant) or death by 50% over 4 years. Reduction of Endpoints i