【高血压精品英文课件】hypertension and crf

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1、HypertensionInChronicKidneyDiseaseRenaldiseaselossofnephronsSystemichypertensionProteinuriaProgressivedeclineinGFRIntroductionRENALINJURYNephronmassGlomerularcapillaryhypertensionGlomerularpermeabilitytomacromoleculesFiltrationofplasmaproteinsProteinuriaExc

2、essivetubularproteinreabsorbtionTubulo-interstitialinflammationRENALSCARRINGSYSTEMICHYPERTENSIONCKD:CommonpathwayindiseaseprogressionTherapeuticinterventioninhibitingthiscommonpathwaymaysucceedinslowingtherateofprogressionofCRFirrespectiveoftheinitiatingcauseCK

3、D:CommonpathwayindiseaseprogressionRelativeriskofESRDaccordingtoquintileBPMRFITstudyN=332,544menHowimportantissystemicbloodpressurecontrol?Treatmentgoalforhypertensioninthegeneralpopulationhasremainedrelativelythesameforthelastdecade.GuidelinesBPtargetBritishH

4、ypertensionSociety(2004)<140/85MalaysianHypertensionSociety<140/90JNCVII(2003)<140/90Whatshouldbethetreatmentgoal?ShouldbelowerthanthegeneralpopulationShouldbetailoredaccordingto:Whatshouldbethetreatmentgoalforrenaldisease?theseverityofrenalfailuretheseverityoft

5、heproteinuriaAggressiveBPcontrolto125/75mmHgshowedbetterpreservationofGFRforthosewithproteinuria>3g/day.Noadditionalbenefitifproteinuriais<1g/dayKlahrS,LeveyAS:NEJM1994;330:877ProteinuriaandtargetBPcontrolGuidelinesTargetBPBritishHypertensionSociety(2004)<130/80

6、MalaysianHypertensionSociety<130/80JNCVII(2003)<130/80Whatshouldbethetreatmentgoalforrenaldisease?TreatmentgoalshoulddependontheseverityofproteinuriaProteinuria(g/d)BPtarget(mmHg)>1125/75<1130/80Whatshouldbethetreatmentgoalfornondiabeticrenaldisease?Thereisindis

7、putableevidencefromanimal,laboratoryandclinicalstudiesthatproteinuriapersecontributestoprogressiverenalinjuryProteinuriaProteinuriaandrenaldiseaseprogressionKlahrS,LeveyAS:NEJM1994;330:877ProteinuriaandrenaldiseaseprogressionREINSUBSTUDY:Progressionofrenaldiseas

8、eaccordingtoseverityofproteinuriaItisnowclearthatdifferentclassesofantihypertensiveagentshavedifferentantiproteinuriccapacityACEIandARBhavebeenshowedtoexhibitthehighe