Developing guidelines on a subject as broad as hypertension is difficult, especially when the guidance relates to hypertension in the chronic kidney disease (CKD) population. The Kidney Disease: Improving Global Outcomes Guideline Development Group has applied a rigorous methodology in reviewing all available evidence, and their recommendations are consistent with the evidence-based approach. As a result, the European Renal Best Practice endorses most of its recommendations. However, the Work Group feels that some additional advice could help clinicians in daily practice: (i) individualization of treatment should be taken into account, especially (cardiovascular) co-morbidities, age, gender and race; (ii) side-effects, such as postural dizziness should be monitored closely, particularly in elderly, diabetics and patients with arterial stiffness; (iii) the importance of salt restriction should not be neglected; (iv) although angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blocker (ARBs) remain a cornerstone in the management of hypertension, and especially cardiovascular protection, in some particular situations such as in advanced CKD and in patients without proteinuria, their role is less well defined; (v) as most CKD patients need more than one antihypertensive drug to achieve blood pressure control, the specific (renal) (dis)advantages of other classes than ACE-I or ARB should be taken into account.

译文

:很难针对广泛的高血压制定指南,尤其是当指南涉及慢性肾脏病(CKD)人群的高血压时。肾脏疾病:改善全球结果指南制定小组在审查所有可用证据时采用了严格的方法,其建议与基于证据的方法一致。因此,欧洲肾脏病最佳实践认可了其大部分建议。但是,工作组认为,一些其他建议可以在临床实践中为临床医生提供帮助:(i)应考虑到个体化治疗,尤其是(心血管)合并症,年龄,性别和种族; (ii)应严密监测姿势性头晕等副作用,尤其是在老年人,糖尿病患者和动脉僵硬患者中; (iii)不应限制盐的重要性; (iv)尽管在某些特殊情况下(例如晚期CKD和无蛋白尿的患者),血管紧张素转换酶抑制剂(ACE-Is)和血管紧张素受体阻滞剂(ARBs)仍是控制高血压,尤其是心血管保护的基础,他们的角色定义不太明确; (v)由于大多数CKD患者需要一种以上的降压药物来控制血压,因此应考虑ACE-1或ARB以外的其他类别的特定(肾脏)(不利)优势。

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