【摘要】 控制高血压是控制慢性肾脏病最重要、最有效的手段。与一般无肾脏病变的高血压患者相比,其血压要求控制更严格。处理的原则是:优先考虑是否能降低血压,同时充分考虑各类降压药对具体患者的情况,包括血压过高的程度,突然或长久上升,心肾功能情况,有否重要代谢异常等加以选择。在现有推荐的降低高血压药物中,利尿剂效果常受肾功能下降影响,ACEI/ARB类对合并蛋白尿者似较优越,但对严重肾功能减退者须慎用。CCB降压效果好并且作用快,常是达到降压目标的包含用药。β受体阻滞剂在肾脏病高血压时不作为主要用药。联合用药在肾脏病合并高血压时十分常见,ACEI或ARB加利尿剂,ACEI或ARB+CCB为最常见的组合。ACEI+ARB虽然对蛋白尿有好处,但是严重心血管并发症者应注意。在高血压治疗过程中必须注意个体差异,治疗方案必须视反应情况作出调整。限制食盐摄入常是肾脏病高血压治疗成功与否的另一关键。更多还原

【Abstract】 Hypertension control is the most important and effective treatment for chronic kidney diseases.Compared with hypertension patients without kidney diseases,it requires a stricter blood pressure control in those with kidney diseases.The treatment principles are:(i)To lower the blood pressure is the top priority;and(ii)the impacts of various antihypertensive drugs on individual patients.The antihypertensive drugs should be chosen taking into consideration of the following factors:the extent of hypertension,whether the hypertension occurs abruptly or permanently,the heart and renal functions and any significant metabolic disorders.Among the existing drugs,diuretic is usually hampered by renal dysfunction;ACEI/ARB seems to be more effective on patients with proteinuria,but it should be used with caution in patients with severe renal insufficiency;CCB is effective and can quickly lower blood pressure,therefore it is an essential drug for hypertension treatment;β-blocker is not considered as a main drug for hypertension with kidney diseases.Combination use of anti-hypertensive drug is common to many CKD with hypertension,among them ACEI/ARB+diuretic,ACEI/ARG+CCB are the most common combinations.ACEI+ARB exhibit a better proteinuria reduction effect;however it is not indicated in patients with severe cardiovascular lesion.Hypertension treatment should take into consideration of individual differences and should be adjusted according to individual responses.Salt intake control also plays an important role in the successful treatment of hypertension with kidney diseases.更多还原