85% of Chinese kidney disease patients fail to lower blood pressure! How hard is it to reduce high blood pressure?
In 2016, Shanghai Ruijin Hospital led a survey on chronic kidney disease complicated with hypertension, involving 6079 Chinese patients. The results showed that the blood pressure control rate of kidney disease patients was only 15.0%.
Although this control rate is a slight improvement from 14.1% in 2012 (a survey led by the PLA General Hospital), it is far from enough. For comparison, the blood pressure control rate for kidney patients in the United States reached 67% in 2010.
Hypertension can cause acute and chronic kidney damage, accelerate the development of renal failure, and cause greater harm to the kidneys and the body than urinary protein. The Lancet, the second-ranked general medical journal in the world, pointed out that in East Asia, including China, and countries in Eastern Europe, tropical Latin America, and Western Saharan Africa, the most damaging factor for chronic kidney disease patients is high blood pressure. blood pressure.
The first is underuse of diuretics. Both thiazide diuretics (5%) and loop diuretics (5.4%) were significantly lower than in the United States (32% and 41%, respectively).
The second is the single use of antihypertensive drugs. Renal hypertension requires a combination of 2-4 antihypertensive drugs, but the proportion of combined use of antihypertensive drugs in China is still far from the United States, and many kidney patients still use a single antihypertensive drug.
In addition, poor patient compliance (non-compliance with doctor's orders) is also an important reason.
Guidelines published by Improving Global Kidney Outcomes say:
In patients with renal disease with urine protein <1g, blood pressure should be controlled within 130/80mmHg;
In patients with renal disease with urine protein>1g, blood pressure should be controlled within 125/75mmHg.
Some friends with kidney disease see that their high blood pressure is 130-140, but they think it is not high, and think that it is high blood pressure if it exceeds 140. this is not right.
140mmHg is the control target for hypertensive patients without heart, brain, kidney and other organ damage. If there is no kidney disease, diabetes and other related diseases, it is pure primary hypertension, then it is no problem to control the blood pressure to less than 140. However, if there are related diseases, the blood pressure target value should be lower.
For patients with moderate to severe proteinuria, this blood pressure is already high
That's why nephrologists give antihypertensive treatment to kidney patients with "not too high blood pressure", not only because pril/sartan drugs can reduce kidney inflammation, but also because the antihypertensive effect will indeed lead to better blood pressure. treatment effect.
Kidney friends reduce systolic blood pressure (high pressure) to below 130 or 125, which can effectively further reduce urinary protein and delay the progression of kidney disease. Is your blood pressure up to target?
A few more digressions: What is the optimal blood pressure for a healthy person?
Recently, the famous medical journal JAMA Cardiovascular Sub-Journal published a study that included 1457 healthy people.
The results of the study showed that compared to people with systolic blood pressure (high pressure) of 90-99 mmHg:
People with high blood pressure of 100-109 mmHg have a 200% increased risk of cardiovascular and cerebrovascular diseases.
People with high blood pressure of 110-119 mmHg have a 210% increased risk of cardiovascular and cerebrovascular disease,
People with high blood pressure of 120-129 mmHg have a 358% increased risk of cardiovascular and cerebrovascular disease.
This study deserves our attention and shows that people with blood pressure in the 90-99 range have a health advantage. Do you still think blood pressure between 120-129 is good? In fact, the risk of cardiovascular and cerebrovascular disease has increased by 358% than others!
Of course, these digressions do not apply to patients with kidney disease, and kidney friends do not necessarily need to lower their blood pressure that much.