高血壓控制與微量白蛋白尿

Control of Hypertension and Microalbuminuria

陳威志(Wei-Chih Chen) ； 陳鏡任(Jenn-Ren Chen) ； 楊士恆(Shih-Heng Yang)

《北市醫學雜誌》 3卷9期 (2006/09) Pp. 837-844

https://doi.org/10.6200/TCMJ.2006.3.9.01

摘要

世界大多數國家中，六十歲以上的人口過半的比例罹患高血壓，由高血壓所引起的心血管疾病，一直名列世界各國的十大死因。近年來高齡人口有增加的趨勢，血壓控制的重要性更不容忽視。高血壓的防治重點於預防併發症的發生，包括腎臟、心血管及腦血管等目標器官的疾病。目前高血壓防治的評估以血壓的測量為主，但是血壓為因應環境需要而隨時都會改變，而其他評估目標器官受損的方法相當耗費時力。微量白蛋白尿(microalbuminuria, MAU)反映出腎臟內皮細胞的傷害，研究顯示高血壓患者的血壓值和尿中白蛋白的排出率成正比，並且對於將來心血管疾病的發生具有指標性，而接受降血壓藥物治療中的白蛋白排出率也和將來心血管危險性成正比，除此之外，抑制腎素－血管張力素－醛固酮系統(renin-antiogensin-aldosterone system, RAAS)除了降血壓外，本身也有助於降低尿白蛋白及之後心血管相關併發症的發生。因此，建議同時合併其他主要心血管危險因子的高血壓患者應該接受定期微量白蛋白尿的檢查，並考慮使用抑制第二型血管張力素作用類的藥物，以降低高血壓患者因腎臟及心血管併發症的罹病率和死亡率。

關鍵字

微量白蛋白尿 ； 高血壓 ； 腎素－血管張力素－醛固酮系統

並列摘要

In many countries, 50% of the population over 60 years of age has hypertension and it is always in the list of the ten leading causes of death. The importance of blood pressure control is to prevent hypertension associated with target organ damage, such as renal and cardiovascular disease. At present, the main assessment of blood pressure control is to monitor the patient's blood pressure values. However, blood pressure is constantly changing according to physiological responses to the surroundings. Evaluating target organ damage is not typically cost effective and involves a tremendous amount of effort. Microalbuminuria reflects damage to the renal filtration barrier. Many studies have shown that the blood pressure of hypertensive patients is directly proportional to their urinary albumin excretion rate, and the in-treatment levels of urinary albumin are closely related to the risk of a subsequent cardiovascular event. Inhibition of the rennin-angiotensin-aldosterone system (RAAS) could lower blood pressure, and also reduce the excretion of urinary albumin and decrease cardiovascular system complications. We suggest that every hypertensive patient with any other major cardiovascular risk factor should receive regular follow-up of microalbuminuria. Also, medication to inhibit the RAAS should be considered as early as possible to decrease the morbidity and mortality of renal and cardiovascular complications associated with hypertension.

並列關鍵字

microalbuminuria ； hypertension ； renin-angiotensin-aldosterone system