85% of Chinese kidney patients failed to lower blood pressure! How hard is it to lower high blood pressure?
In 2016, Shanghai Ruijin Hospital took the lead in conducting a survey of chronic kidney disease complicated with hypertension, involving 6079 Chinese patients, and 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 (data from a survey led by the PLA General Hospital), it is far from enough. As a comparison, the blood pressure control rate of kidney friends in the United States reached 67% in 2010.
High blood pressure can cause acute and chronic kidney damage, accelerate the development of kidney failure, and do more harm to the kidneys and body than urine protein. The Lancet, the second-ranked general medical journal in the world, pointed out that in East Asia including China, Eastern Europe, tropical Latin America and Western Sahara Africa, the most damaging factor for chronic kidney disease patients is high blood pressure.
The first is insufficient use of diuretics. Both the use of thiazide diuretics (5%) and loop diuretics (5.4%) were much lower than in the United States (32% and 41%, respectively).
Followed by a single use of antihypertensive drugs. Renal hypertension requires a combination of 2-4 antihypertensive drugs, but the ratio of combined use of antihypertensive drugs in China is still far behind that of the United States, and many renal patients are still using a single antihypertensive drug.
In addition, poor patient compliance with medication (non-compliance with doctor's advice) is also an important reason.
Guidelines issued by Improving Global Kidney Outcomes state that:
For kidney disease patients with urinary protein <1g, blood pressure should be controlled within 130/80mmHg;
For kidney disease patients with urinary protein > 1g, blood pressure should be controlled within 125/75mmHg.
Some friends with kidney disease see that their blood pressure is 130-140, and 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 or other related diseases, it is pure essential hypertension, then it is no problem to control the blood pressure to less than 140. However, if accompanied by related diseases, the blood pressure target value should be lower.
For patients with moderate and severe proteinuria, this blood pressure is already high
That's why nephrologists will give antihypertensive treatment to kidney friends with "not high blood pressure". treatment effect.
Kidney friends lower the systolic blood pressure (high pressure) to below 130 or 125, which can effectively further reduce urine protein and delay the progress of kidney disease. Is your blood pressure up to target?
Let me say 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.
Compared to people with a systolic (high pressure) blood pressure (high pressure) of 90-99 mmHg, the results of the study showed:
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% higher risk of cardiovascular and cerebrovascular diseases.
People with high blood pressure of 120-129 mmHg have a 358% higher risk of cardiovascular and cerebrovascular diseases.
This study is worthy of our attention, showing that people with blood pressure in the 90-99 range have a health advantage. Do you still think blood pressure between 120-129 is very good? In fact, the risk of cardiovascular and cerebrovascular diseases has increased by 358% compared to others!
Of course, these few digressions do not apply to patients with kidney disease. Kidney friends do not necessarily have to lower blood pressure so low.