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首页> 外文期刊>Archives of Internal Medicine >Long-term effects of renin-angiotensin system-blocking therapy and a low blood pressure goal on progression of hypertensive chronic kidney disease in African Americans.
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Long-term effects of renin-angiotensin system-blocking therapy and a low blood pressure goal on progression of hypertensive chronic kidney disease in African Americans.

机译：长期影响肾素-血管紧张素机制来阻止治疗和低血压目的慢性高血压的进展肾脏疾病在非洲裔美国人。

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BACKGROUND: Antihypertensive drugs that block the renin-angiotensin system (angiotensin-converting enzyme inhibitors [ACEIs] or angiotensin receptor blockers) are recommended for patients with chronic kidney disease (CKD). A low blood pressure (BP) goal (BP, <130/80 mm Hg) is also recommended. The objective of this study was to determine the long-term effects of currently recommended BP therapy in 1094 African Americans with hypertensive CKD. METHODS: Multicenter cohort study following a randomized trial. Participants were 1094 African Americans with hypertensive renal disease (glomerular filtration rate, 20-65 mL/min/1.73 m2). Following a 3x2-factorial trial (1995-2001) that tested 3 drugs used as initial antihypertensive therapy (ACEIs, calcium channel blockers, and beta-blockers) and 2 levels of BP control (usual and low), we conducted a cohort study (2002-2007) in which participants were treated with ACEIs to a BP lower than 130/80 mm Hg. The outcome measures were a composite of doubling of the serum creatinine level, end-stage renal disease, or death. RESULTS: During each year of the cohort study, the annual use of an ACEI or an angiotensin receptor blocker ranged from 83.7% to 89.0% (vs 38.5% to 49.8% during the trial). The mean BP in the cohort study was 133/78 mm Hg (vs 136/82 mm Hg in the trial). Overall, 567 participants experienced the primary outcome; the 10-year cumulative incidence rate was 53.9%. Of 576 participants with at least 7 years of follow-up, 33.5% experienced a slow decline in kidney function (mean annual decline in the estimated glomerular filtration rate, <1 mL/min/1.73 m2). CONCLUSION: Despite the benefits of renin-angiotensin system-blocking therapy on CKD progression, most African Americans with hypertensive CKD who are treated with currently recommended BP therapy continue to progress during the long term.
机译：背景:抗高血压药物阻止肾素-血管紧张素系统(血管紧张素转换酶抑制剂(acei)或血管紧张素受体阻滞剂)建议患者慢性肾脏疾病(CKD)。压(BP)的目标(BP, < 130/80毫米汞柱)推荐。目前确定的长期影响推荐1094年英国石油公司(BP)治疗非裔美国人高血压与慢性肾病。队列研究随机试验。受试者1094名非洲裔美国人高血压肾病(肾小球滤过率、20 - 65 mL / min / 1.73平方米)。3 x2-factorial试验(1995 - 2001),测试3药物作为初始抗高血压治疗(acei、钙通道阻滞剂和β受体阻断剂)和2 BP控制(通常的水平和低),我们进行了一项队列研究(2002 - 2007)参与者与acei治疗英国石油公司低于130/80毫米汞柱,结果措施是一个复合的两倍血清肌酐水平,终末期肾病,或死亡。研究中,年度使用ACEI或一个血管紧张素受体阻滞剂从83.7%不等试验期间(89.0% vs 38.5%到49.8%)。意味着英国石油(BP)的队列研究是133/78毫米汞柱(vs试验中136/82毫米汞柱)。参与者有经验的主要结果;10年累积发病率为53.9%。至少7年的576名参与者随访,33.5%经历了一个缓慢的下降肾功能(平均每年下降估计肾小球滤过率,< 1mL / min / 1.73平方米)。肾素-血管紧张素机制来阻止治疗慢性肾病进展,大多数非洲裔美国人目前高血压治疗的慢性肾病建议英国石油(BP)治疗继续进步在长期的。

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