135 mmhg 85 [3] JNC mmhg 90 mmhg 120 mmhg 80 mmhg [1] 60 ml/min/1.73m 2 6.9% 1. (GFR)

Transcription

1 JNC mmhg 90 mmhg 120 mmhg80 mmhg [1] mmhg85 mmhg mmhg 85 mmhg [2] [3] 60 ml/min/1.73m 2 [4] ( 1) 6.9% 1. (GFR) ( )

2 71.4% [5] GFR 130/80 mmhg (1 g) 125/75 mmhg [6] Angiotension converting enzyme inhibitor ( ) Angiotension receptor blocker ( )130/80 mmhg %[7]2 [4] 2. bradykinins (EPO) / 2 U 150 mmhg 110 mmhg [8] (target organ)

3 [9] 1. ( ) 35% 40% 2. 20% 25% RENAAL mmhg 130 mmhg 38%10 mmhg 6.7% [10] 5. [11] (body mass index ) [11] DASH (Dietary Approaches to Stop Hypertension) [12] 2.4 g ( 6 g) [12] 30 [13] 30 cc15 cc (30 cc 300 cc) [13] [14] thiazide [15] [16] thiazide (ACEI) (ARB)

4 [17]3 [1] [18]MARVAL (Diovan) (Amlodipine) (-44% -18%) [19] [4] 1. ACEI ARBs 2. ACEIs ARBs 3. ACEIs ARBs 4. ACEIs ARBs ACEIs ARBs (1) 30% (2) 5.5 meq/l 7. ACEIs ARBs 35% ACEI ACEI IRMA2 irbesartan 300 mg 150mg[20] 3. ACE

5 ARB ACEI() (50.9% vs 16.4%) [21] ARB ( ) 3081 ARB (Valsartan) non-arb ARB 39% 40% 46% 65% [22]ARB ACEI thiazide furosemide [23] [24] ( )[25] [11] (1) (2) ( ) (3) (4) a. b. c. d. NSAID e. f. g. 3. a. b. c. d. 4. a. b. c. d. 5. a. b. 30 cc

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7 endpoint morbidity-mortality study: Lancet 2007; 369: Minutolo R, De Nicola L, Zamboli P, et al: Management of hypertension in patients with CKD: differences between primary and tertiary care settings. Am J Kidney Dis 2005; 46: Santos, Sergio FF, Aldo JP: Hypertension in dialysis. Current Opinion in Nephrology & Hypertension. 2005; 14: Lozano A, Benavides B, Quiros P, et al: Control of arterial hypertension by means of a regimen of hemodialysis on alternate days versus 2 conventional regiments of 4 and 5 hours per session 3 times a week with 72 hours without sessions during the weekends. Nephrology 2006; 26: Agarwal R, Andersen MJ: Correlates of systolic hypertension in patients with chronic kidney disease. Hypertension 2005; 46: Agarwal R: Hypertension in chronic kidney disease and dialysis: pathophysiology and management. Cardiol Clin 2005; 23: Andersen MJ Agarwal R: Etiology and management of hypertension in chronic kidney disease. Med Clin North Am 2005; 89: