第6巻 2010年2月　第1号

■臨床医のために

慢性腎臓病合併例の高血圧治療
内海　甲一, 平間　章郎, 上田　佳恵, 三井　亜希子, 金子　朋広, 飯野　靖彦, 片山　泰朗
日本医科大学大学院医学研究科神経・腎臓・膠原病リウマチ学

Management of Hypertension in Patients with Chronic Kidney Disease
Kouichi Utsumi, Akio Hirama, Kae Ueda, Akiko Mii, Tomohiro Kaneko, Yasuhiko Iino and Yasuo Katayama
Department of Neurological, Nephrological, and Rheumatological Science, Graduate School of Medicine, Nippon Medical School

Chronic kidney disease (CKD) is defined by two criteria. One criterion is abnormal renal function or morphology, especially proteinuria. A second criterion is an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m² calculated with the serum creatinine concentration. CKD is classified on the basis of eGFR from stage 1 to stage 5. CKD is a common cause of cardiovascular disease (CVD). CVD is a major cause of morbidity and mortality in patients with CKD. Management of hypertension in patients with CKD aims to prevent CVD and provide renoprotection. First-line agents for controlling blood pressure are inhibitors of the renin-angiotensin system: angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. These agents are superior to other classes of antihypertensive agents in reducing the amount of urinary protein and in preserving renal function. In CKD, the target blood pressure is less than 130/80 mmHg, and 125/75 mmHg, if the amount of urinary protein is more than 1 g/day. To achieve the target blood pressure, other classes of antihypertensive agents, such as diuretics and calcium channel blockers, should also be administered.

日医大医会誌 2010; 6(1), 17-22

Key words
chronic kidney disease, cardiovascular disease, renin-angiotensin system, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers

Correspondence to
Kouichi Utsumi, Department of Neurological, Nephrological, and Rheumatological Science, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：utsumi@nms.ac.jp

受付：2009年6月24日　受理：2009年8月7日