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1、Epidemiologyof RenalDiseasein HypertensionRichardBright,M.D.F.R.S.1789-1858FatherofNephrologyRenalDiseaseinHypertensionEpidemiologyEffectsofhypertensiononthekidneyInteractionsofhypertensionandconcomitantconditionsonthekidneyAgeAtherosclerosisDiabetesmellitusRaceMorbidity&mortalityass
2、ociatedwithchronicrenaldiseaseCoronaryarterydiseaseProgressionofchronicrenaldiseaseEndStageRenalDisease(ESRD)HypertensionasaconsequenceofESRDRenalDiseaseinHypertensionAHistoricalPerspectiveTraube(Berlin,1856)“HighBloodPressureIsNeeded”Postulatedthatarterialpressurewaselevatedtooverco
3、memechanicalresistanceagainstbloodflowthroughthickenedarteries.Believedthatincreasedbloodpressurewasnecessaryforexcretoryefficiencyofthekidney.Promotedtheseconceptswhichwereunchallengedforalmost80years.Page(Cleveland,1934)“HighBloodPressureIsNOTNecessary”Developedrenalclearancetechni
4、questhatestimatedrenalbloodflowinhumans.Reducedelevatedbloodpressurewithoutafallinureaclearance.Demonstratedthatearlyantihypertensivemeasureswerenotdetrimentaltorenalfunction.Radicalsympathectomyinessential&malignanthypertensionsafelyloweredarterialbloodpressurewithoutlossofrenalfunc
5、tion.RiskFactorsfor ProgressionofRenalDiseaseCanbemodifiedCannotbemodifiedHypertensionAgeAlbuminuria/ProteinuriaEthnicityDyslipidemiaGenderHemoglobinA1CSmokingAnemiaCa?P04ESRDDuetoAnyCause In332,544MenScreenedforMRFITAdjustedRelativeRisk§Hypertension§Menwithoptimalbloodpressurewasthe
6、referencecategory.KlagMJ,etal.NEnglJMed.1996;334(1):13-18.*p<0.001HTNLinkedToChronicRenalDiseaseAmong332,544MenScreenedforMRFIT<8080-8485-8990-99100-109?110Age-AdjustedRateofESRDPer100,000Person-Years?180160-179140-159130-139120-129<120SystolicBP(mmHg)DiastolicBP(mmHg)AdaptedfromKlag
7、MJ,etal.NEnglJMed.1996;334(1):13-18.?MassachusettsMedicalSocietyIncidenceRatesofReported ESRDbyPrimaryDiagnosisYearUnitedStatesRenalDataSystem(USRDS)2000AnnualDataReport?WWW.USRDS.ORGDiabetes50%Hypertension27%Glomerulonephritis13%Other10%PrimaryDiagnosesfor PatientsWhoStartDialysisUn
8、itedStatesRe
