Josep Redon ESH副主席 西班牙瓦伦西亚大学

       <International Circulation>:  :You have investigated the role of blood pressure on renal damage. What is the influence of high blood pressure on the development of end-stage renal disease in those with non-diabetic， chronic renal failure?

  《国际循环》：您曾研究血压在肾脏损害中所起的作用，请问高血压对非糖尿病性慢性肾衰竭患者终末期肾脏疾病的进展有何影响？
    Prof.Redon: The discussion on the relationship between blood pressure and renal damage goes back more than a century. Initially the question was whether the kidney was the culprit of hypertension or the victim of hypertension. At that time， this was the most important issue because the consequences of high blood pressure were focused in the kidney. Later on， the importance of hypertension in developing vascular damage in general and increased cardiovascular risk， put the kidney’s role in a new perspective in terms of the kidney being a very good sensor of what is happening in the vascular tree. This progressed to the use of markers from the kidney being used as a prognostic basis for cardiovascular disease. I am referring to initially proteinuria and later on， bicarbonaturia， and later still， glomerular filtration rate. Of course it is clear that high blood pressure is an important contributor to developing chronic kidney disease and to bring people with chronicities to the end-stage of renal disease. This is more frequent and impressive in people with diabetes but it happens to people without diabetes or without any primary renal diseases. What made the assessment of this difficult was being aware of what was happening as the changes in renal function occurred very slowly and it took a long time to realize that the patient was heading not only towards chronic renal disease but renal insufficiency. Sometimes this relationship between blood pressure and the kidney is neglected a little bit. It seems clear what we can do to avoid this – the better the control of blood pressure， the better the protection of the kidney. To protect the kidney， we need to take into account one special component of blood pressure and that is the importance of nocturnal blood pressure. Nocturnal blood pressure has more impact on the glomerulus of the kidney and at night is when the glomerulus is more exposed to the vascular system and blood pressure. This is why patients with chronic kidney disease have what is called a non-dipper pattern. That is， they have less reduction of blood pressure at night. So to protect the kidney， we need to be sure we are doing so 24 hours a day and we are able to reduce blood pressure in these patients for the full 24 hours.

    Redon 教授：血压和肾脏损害关系的讨论可以追溯到一百多年前。最初问题是肾脏是引起高血压的元凶，还是高血压的受害者。那时，这是最重要的问题，因为高血压的预后与肾脏息息相关。随后，高血压在引起全身血管损害和增加心血管风险中所起的重要作用使人们重新审视肾脏的作用，因为其可视为很好的感受血管树变化的感受器，这后来发展为应用肾脏的标志物作为心血管疾病预后的根据，即最初应用蛋白尿，随后应用重碳酸氢盐尿，再后来应用肾小球滤过率。当然，高血压是进展成慢性肾脏疾病的重要促发因素，并使慢性肾脏疾病进展成终末期肾脏疾病。这在糖尿病患者中更常见、更引人注意，但也发生于无糖尿病或原发性肾脏疾病者。因为肾脏功能变化非常缓慢，需要很长时间才能认识到患者不仅向慢性肾脏疾病进展，而是向肾功能不全进展，所以很难觉察也很难评估正在发生的这些变化。有时血压和肾脏的关系易被忽略。我们通常认为，血压控制的越好，肾脏保护的越好。为了保护肾脏，我们需要考虑血压中的特殊组分，即夜间血压的重要性。夜间肾小球更多地暴露于血管系统和血压，因此夜间血压对肾小球的影响较大。这就是慢性肾脏疾病患者具有称之为非杓型高血压的原因，即他们在夜间血压下降较少。因此，为了保护肾脏，我们需要确保24小时都能降低患者的血压。