Korean Journal of Nephrology 1991;10(2):135-144.
만서 신부전증 환자에서 고혈압이 신부전증의 진행속도에 미치는 영향
한대석 , 최규헌 , 김영기 , 차동훈 , 이호영 , 김교순
Abstract
In order to investigate the effect of hypertension on the progresion of renal insufficiency in chronic renal failure patients, we evaluated the relationship of decline in renal function reflected by a slope of reciprocal serum creatinine against time to blood pressure. The plasma creatinine was measured at least 4 times regularly during over 6 months of follow-up period. The following results were obtained. 1) The male to female ratio was l. 7:1, and the mean age, duration of follow-up, number of data points per patient and serum creatinine concentration at first con- tact were 47.1 years, 28.5 months, 8.8 times, and 3.3 mg/dl, respectively. 2) The causes of chronic renal failure were chronic glomerulonephritis, diabetic nephropathy, hypertensive nephrosclerosis, in order, and 80% of patients were treated with antihyertensive medications such as diur- etics or beta-blockers. The average value of blood pressure measured during follow-up period was 158.7/ 98. 3 mmHg. 3) The mean progression rate of renal failure was 0,0140±0.0011 (M±S.E) dl/mg.month, and that in dia- betic patients tended to be faster than patients affected with non-diabetic renal diseases. 4) The rate of decline of renal function tended to be accelerated according to a increase of systolic blood pressure, though the statistical significance was not shown. 5) The patients with a mean diastolic blood pressure of less than 90 mmHg had a significantly slower pro- gression rate of renal failure than patients with more than 90 mmHg (M±S.E, - 0.0101±0.0017 dl/mg.month vs - 0.0158±0.0013, p<0.05), but a comparison of the progression rate according to level of diastolic blood pressure in patients with same renal disease did not show marked differences. 6) There was no statistically singificant difference of a declining rate in reeiprocal creatinine or level of blood .pressure according to the age, sex or underlying renal disease. From the above results, it seems that in patients with chronic renal failure, control of blood pressure to values less than 90 mmHg can be an effective way to slow the rate of progression of renal insufficiency, but further prospective studies evaluating the changes of actual glomerular filtration rate and the effectiveness of spe- cific antihypertensive agents will be needed.
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