高血压肾病的循证降压课件.ppt

高血压肾病的循证降压eGFR(ml/min/1.73m2)03122436BaselineUp/Cr0.2205-5-10-15-20ΔGFR(mL/min/y)Amlodipine-5.62Ramipril-3.60TotalslopeAmlodipinevsramipril:?=-6.06,p=0.006JAMA.?2001;285:2719-2728.MonthsAASK高血压肾病的循证降压JAMA.?2001;285:2719-2728eGFR(ml/min/1.73m2)031224360510-5-10MeanBaselineGFR≥40ml/minper1.73m2ΔGFR(mL/min/y)Amlodipine-0.55Ramipril-1.53TotalslopeAmlodipinevsramipril:?=-2.91,p=0.003MonthsAASK高血压肾病的循证降压eGFR(ml/min/1.73m2)0312243605-5-10-15-20JAMA.?2001;285:2719-2728.MonthsMeanBaselineGFR40ml/minper1.73m2ΔGFR(mL/min/y)Amlodipine-4.33Ramipril-2.73TotalslopeAmlodipinevsramipril:?4.83,p=0.003AASK高血压肾病的循证降压没有明显蛋白尿(UP/Cr?0.22)和肾功能损害早期（GFR≥40ml/min）高血压肾病明显蛋白尿(UP/Cr0.22)或肾功能损害晚期（GFR40ml/min）CCB获益更大些ACEI获益更大些ischemichypertrophic启示高血压肾病的循证降压高血压肾病的循证降压高血压肾病的循证降压**SlideI-14高血压是导致终末期肾脏病（ESRD）第二大病因ThepiechartshowsthatdiabetesiscurrentlythemostcommoncauseofESRD.ThelowergraphrevealsthatthenumberofpatientswithESRDmaintainedondialysisispredictedtodoubleoverpresentlevelsby2010,andthemajorcontributortothisexponentialincreaseischronicrenalfailureassociatedwithdiabetes.UnitedStatesRenalDataSystem.Annualdatareport.2000.[Accessedon25April2001]AvailableatURL:/adr.htm.要减少高血压病引起的ESRD,就要循证降压.*PURPOSEOFREVIEW:Hypertensivenephrosclerosisisthesecondmostcommoncauseofend-stagerenaldisease,howevermorphologicevidenceonthesubjectispoorlyunderstood.Aperennialandvexingprobleminunderstandingkidneyhypertensionisthatcorrelationsbetweenhypertensionandvascularandglomerularlesionsareonlymoderate,inpartbecausealloftheselesionsarepresenttoagreaterorlesserdegreeinthenormotensive,agingkidney,withracialdifferencesinseverityfurthercompound