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学科主题: 临床医学
题名:
Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis
作者: Lv, Jicheng1,2; Ehteshami, Parya1; Sarnak, Mark J.3; Tighiouart, Hocine3; Jun, Min1; Ninomiya, Toshiharu4; Foote, Celine1; Rodgers, Anthony1; Zhang, Hong2; Wang, Haiyan2; Strippoli, Giovanni F. M.5,6,7; Perkovic, Vlado1
刊名: CANADIAN MEDICAL ASSOCIATION JOURNAL
发表日期: 2013-08-06
DOI: 10.1503/cmaj.121468
卷: 185, 期:11, 页:949-957
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Medicine, General & Internal
研究领域[WOS]: General & Internal Medicine
关键词[WOS]: CHRONIC RENAL-DISEASE ; OPTIMAL TREATMENT HOT ; HYPERTENSION ; TRIAL ; PROTEINURIA ; HEALTH ; PARTICIPANTS ; PREVENTION ; GUIDELINES ; MANAGEMENT
英文摘要:

Background:

Recent guidelines suggest lowering the target blood pressure for patients with chronic kidney disease, although the strength of evidence for this suggestion has been uncertain. We sought to assess the renal and cardiovascular effects of intensive blood pressure lowering in people with chronic kidney disease.

Methods:

We performed a systematic review and meta-analysis of all relevant reports published between 1950 and July 2011 identified in a search of MEDLINE, Embase and the Cochrane Library. We included randomized trials that assigned patients with chronic kidney disease to different target blood pressure levels and reported kidney failure or cardiovascular events. Two reviewers independently identified relevant articles and extracted data.

Results:

We identified 11 trials providing information on 9287 patients with chronic kidney disease and 1264 kidney failure events (defined as either a composite of doubling of serum creatinine level and 50% decline in glomerular filtration rate, or end-stage kidney disease). Compared with standard regimens, a more intensive blood pressure-lowering strategy reduced the risk of the composite outcome (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.68-0.98) and end-stage kidney disease (HR 0.79, 95% CI 0.67-0.93). Subgroup analysis showed effect modification by baseline proteinuria (p = 0.006) and markers of trial quality. Intensive blood pressure lowering reduced the risk of kidney failure (HR 0.73, 95% CI 0.62-0.86), but not in patients without proteinuria at baseline (HR 1.12, 95% CI 0.67-1.87). There was no clear effect on the risk of cardiovascular events or death.

Interpretation:

Intensive blood pressure lowering appears to provide protection against kidney failure events in patients with chronic kidney disease, particularly among those with proteinuria. More data are required to determine the effects of such a strategy among patients without proteinuria.

语种: 英语
项目资助者: Amgen Renal Research Fellowship ; Australian Heart Foundation Career Development Award
WOS记录号: WOS:000322816700026
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/59169
Appears in Collections:北京大学第一临床医学院_肾脏内科_期刊论文

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作者单位: 1.Univ Sydney, George Inst Global Hlth, Sydney, NSW, Australia
2.Tufts Med Ctr, Boston, MA USA
3.DIAVERUM Med Sci Off, Lund, Sweden
4.Peking Univ, Hosp 1, Div Renal, Dept Med, Beijing 100871, Peoples R China
5.Kyushu Univ, Dept Med & Clin Sci, Grad Sch Med Sci, Fukuoka 812, Japan
6.Univ Sydney, Childrens Hosp Westmead, Sch Publ Hlth, Ctr Kidney Res, Sydney, NSW 2006, Australia
7.Mario Negri Sud Consortium S Maria Imbaro, Dept Pharmacol & Epidemiol, Chieti, Italy

Recommended Citation:
Lv, Jicheng,Ehteshami, Parya,Sarnak, Mark J.,et al. Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis[J]. CANADIAN MEDICAL ASSOCIATION JOURNAL,2013,185(11):949-957.
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