資源描述：
《高血壓腎病的循證降壓》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在教育資源-天天文庫(kù)。
1、高血壓腎病的循證降壓從病理生理到ALLHAT與AASK研究的思考溫州醫(yī)學(xué)院附屬第一醫(yī)院腎內(nèi)科陳天新PrimaryDiagnosisForPatientsWhoStartDialysisDiabetes50.1%Hypertension27%Glomerulonephritis13%Other10%UnitedStatesRenalDataSystem.Annualdatareport.2000.NoofPatientsProjection95%CI198419861988199019921994199619982000200220042006200820
2、100100200300400500600700R2=99.8%243,524281,355520,240NumberofDialysisPatients(thousands)高血壓病是ESRD第二大病因ALLHAT和AASK研究病理生理高血壓腎病的循證降壓病理生理HillGS,CurrOpinNephrolHypertens.2008May;17(3):266-70HypertensivenephrosclerosisIschemicFSGSHypertrophicFSGSChronichypertensionNarrowofinterlobular,
3、afferentarterioleReductioninglomerularbloodflowRenalbloodflowGFR01002001.51.00.50Flow,l/minArterialbloodpressure,mmHgAutoregulationofRBF&GFRi.e.theresistancesoftheinterlobularartery,afferentarteriole病理生理http://www.pathologyoutlines.com/kidney.html病理生理病理生理HillGS,CurrOpinNephrolHyp
4、ertens.2008May;17(3):266-70HypertensivenephrosclerosisIschemicFSGSHypertrophicFSGSNarrowandstiffeningarterioleReductioninglomerularbloodflowLossofrenalautoregulationLossofrenalfunctionHarveyJM,Lancet1992Dec12;340(8833):1435-6讓我們看看大樣本臨床試驗(yàn)ALLHAT研究和AASK研究病理生理臨床試驗(yàn)IschemicHypertrophic
5、能否找到臨床指標(biāo)來(lái)判斷那種模式為主呢?RahmanMetal.ArchInternMed2005;165:936-46AntihypertensiveandLipid-LoweringtreatmenttopreventHeartAttackTrialALLHAT42,418patientswithhypertensionSBP>140mmHgand/orDBP>90mmHgORTookmedicationforhypertensionandhadatleastoneadditionalriskfactorforCHDAge>55yearsNHLBIfu
6、ndedtrialEndpoints:Primary–FatalcoronaryheartdiseaseandnonfatalMIeGFR(ml/min/1.73m2)RahmanMetal.ArchInternMed2005;165:936-46*p<0.05vs.Chlorthalidone***BaselineeGFR≥90(ml/min/1.73m2)ALLHATeGFR(ml/min/1.73m2)RahmanMetal.ArchInternMed2005;165:936-46*p<0.05vs.Chlorthalidone***Baselin
7、eeGFR60-89(ml/min/1.73m2)TotalΔGFR(mL/min/y)C-1.54A-0.55L-1.471styearΔGFR(mL/min/y)C-2.3A+1.5L-1.9FollowingΔGFR(mL/min/y)C-1.3A-1.2L-1.4ALLHATeGFR(ml/min/1.73m2)RahmanMetal.ArchInternMed2005;165:936-46*p<0.05vs.Chlorthalidone***BaselineeGFR<60(ml/min/1.73m2)TotalΔGFR(mL/min/y)C-0
8、.50A+0.23L-0.451styearΔGFR(mL/min/y)C+0.
