血压变异性与肾脏疾病风险的研究与临床干预
Research Advances and Clinical Intervention on Blood Pressure Variability and Kidney Disease Risk
摘要: 慢性肾脏病(Chronic Kidney Disease, CKD)和急性肾损伤(Acute Kidney Injury, AKI)是全球健康挑战。传统血压管理侧重于平均血压，但近年研究表明，血压变异性(blood pressure variability, BPV)本身即是心、肾等靶器官损害的独立危险因素。这篇综述系统梳理了BPV与CKD进展、AKI发生之间的研究证据，探讨其潜在的发病机制，总结了不同人群中的特点，并评述当前BPV的评估方法和临床干预策略。现有证据支持将BPV纳入肾脏疾病的综合风险评估体系中。未来还需要统一BPV的测量和管理标准，从而实现更全面的血压管理与肾脏保护。
Abstract: Chronic kidney disease (CKD) and acute kidney injury (AKI) represent significant global health challenges. While conventional blood pressure management has focused primarily on average blood pressure levels, emerging evidence indicates that blood pressure variability (BPV) itself serves as an independent risk factor for damage to target organs such as the heart and kidneys. This review systematically examines the evidence linking BPV to CKD progression and AKI onset, explores potential underlying pathophysiological mechanisms, summarizes population-specific characteristics, and evaluates current methods for assessing BPV along with relevant clinical intervention strategies. Available data support the integration of BPV into comprehensive risk assessment frameworks for kidney disease. Moving forward, standardized approaches for measuring and managing BPV are needed to advance more holistic blood pressure control and renal protection.
文章引用：李佳芸, 廖晓辉. 血压变异性与肾脏疾病风险的研究与临床干预[J]. 临床医学进展, 2026, 16(2): 532-537. https://doi.org/10.12677/acm.2026.162422

参考文献

[1] Mark, P.B., Stafford, L.K., Grams, M.E., Aalruz, H., Abd ElHafeez, S., Abdelgalil, A.A., et al. (2025) Global, Regional, and National Burden of Chronic Kidney Disease in Adults, 1990-2023, and Its Attributable Risk Factors: A Systematic Analysis for the Global Burden of Disease Study 2023. The Lancet, 406, 2461-2482. [Google Scholar] [CrossRef] 
[2] Hoste, E.A.J., Kellum, J.A., Selby, N.M., Zarbock, A., Palevsky, P.M., Bagshaw, S.M., et al. (2018) Global Epidemiology and Outcomes of Acute Kidney Injury. Nature Reviews Nephrology, 14, 607-625. [Google Scholar] [CrossRef] [PubMed]
[3] Stevens, P.E., Ahmed, S.B., Carrero, J.J., Foster, B., Francis, A., Hall, R.K., et al. (2024) KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International, 105, S117-S314. [Google Scholar] [CrossRef] [PubMed]
[4] Parati, G., Ochoa, J.E., Lombardi, C. and Bilo, G. (2013) Assessment and Management of Blood-Pressure Variability. Nature Reviews Cardiology, 10, 143-155. [Google Scholar] [CrossRef] [PubMed]
[5] Narita, K., Hoshide, S. and Kario, K. (2023) Short-To Long-Term Blood Pressure Variability: Current Evidence and New Evaluations. Hypertension Research, 46, 950-958. [Google Scholar] [CrossRef] [PubMed]
[6] Mahinrad, S., Bennett, D.A., Sorond, F.A. and Gorelick, P.B. (2023) Blood Pressure Variability, Dementia, and Role of Antihypertensive Medications in Older Adults. Alzheimer’s & Dementia, 19, 2966-2974. [Google Scholar] [CrossRef] [PubMed]
[7] Kulkarni, S., Parati, G., Bangalore, S., Bilo, G., Kim, B.J., Kario, K., et al. (2025) Blood Pressure Variability: A Review. Journal of Hypertension, 43, 929-938. [Google Scholar] [CrossRef] [PubMed]
[8] Jhee, J.H., Oh, D., Seo, J., Lee, C.J., Chung, M., Park, J.T., et al. (2023) Short-term Blood Pressure Variability and Incident CKD in Patients with Hypertension: Findings from the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (CMERC-HI) Study. American Journal of Kidney Diseases, 81, 384-393.e1. [Google Scholar] [CrossRef] [PubMed]
[9] Huh, Y., Kim, H. and Park, H.S. (2025) Blood Pressure Variability and End‐Stage Kidney Disease among Individuals with Type 2 Diabetes: A Nationwide Cohort Study. Journal of Diabetes, 17, e70160. [Google Scholar] [CrossRef] 
[10] Rostamian, S., Kaura, A., Ariti, C., Gupta, A., Whitely, W., Poulter, N.R., et al. (2025) The Impact of Blood Pressure Variability on Cardiovascular and Renal Outcomes in Patients with and without Diabetes: Insights from the Anglo-Scandinavian Cardiac Outcomes Trial. Journal of Hypertension, 43, 2033-2041. [Google Scholar] [CrossRef] 
[11] Yang, L., Li, J., Wei, W., Pu, Y., Zhang, L., Cui, T., et al. (2023) Blood Pressure Variability and the Progression of Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Journal of General Internal Medicine, 38, 1272-1281. [Google Scholar] [CrossRef] [PubMed]
[12] Tang, C., Zhang, X., Lv, J., Shi, S., Zhou, X., Liu, L., et al. (2022) Visit-to-Visit Variability in Blood Pressure and Kidney Disease Progression in IgA Nephropathy. Clinical Kidney Journal, 15, 2331-2339. [Google Scholar] [CrossRef] [PubMed]
[13] Li, Y., Zheng, T., Zhu, J., Chen, Y., Chen, Y. and Sun, S. (2023) Variability of Blood Pressure and Risk of Postoperative Acute Kidney Injury in Patients Undergoing Surgery for Acute Aortic Dissection: A 11‐Year Single‐Center Study. The Journal of Clinical Hypertension, 25, 463-469. [Google Scholar] [CrossRef] [PubMed]
[14] Xiao, R., Luo, M., Yu, H., Zhang, Y., Long, F., Li, W., et al. (2025) Relationship between Intraoperative Blood Pressure Variability and Postoperative Acute Kidney Injury in Pediatric Cardiac Surgery. Pediatric Nephrology, 40, 2071-2081. [Google Scholar] [CrossRef] [PubMed]
[15] Nugent, J.T., Ghazi, L., Yamamoto, Y., Bakhoum, C., Wilson, F.P. and Greenberg, J.H. (2023) Hypertension, Blood Pressure Variability, and Acute Kidney Injury in Hospitalized Children. Journal of the American Heart Association, 12, e029059. [Google Scholar] [CrossRef] [PubMed]
[16] Honda, A., Tahara, N., Tahara, A., Bekki, M., Maeda-Ogata, S., Sugiyama, Y., et al. (2023) Effects of Olmesartan and Amlodipine on Blood Pressure, Endothelial Function, and Vascular Inflammation. Journal of Nuclear Cardiology, 30, 1613-1626. [Google Scholar] [CrossRef] [PubMed]
[17] Arendshorst, W.J., Vendrov, A.E., Kumar, N., Ganesh, S.K. and Madamanchi, N.R. (2024) Oxidative Stress in Kidney Injury and Hypertension. Antioxidants, 13, Article 1454. [Google Scholar] [CrossRef] [PubMed]
[18] Ghanim, H., Thethi, T.K., Abuaysheh, S., Fonseca, V. and Dandona, P. (2023) Vasoactive Mediators of Hypertension in Obesity. American Journal of Physiology-Endocrinology and Metabolism, 325, E406-E411. [Google Scholar] [CrossRef] [PubMed]
[19] Yamashita, N. and Kramann, R. (2024) Mechanisms of Kidney Fibrosis and Routes Towards Therapy. Trends in Endocrinology & Metabolism, 35, 31-48. [Google Scholar] [CrossRef] [PubMed]
[20] Yang, J., Huang, J., Yu, B., Zhang, Q., Zhang, S., Wu, L., et al. (2022) Long‐Term Predialysis Blood Pressure Variability and Outcomes in Hemodialysis Patients. The Journal of Clinical Hypertension, 24, 148-155. [Google Scholar] [CrossRef] [PubMed]
[21] Liu, Q., Wang, W., Wu, X., Lv, J., Cai, S. and Li, Y. (2023) Intra-Dialytic Blood Pressure Variability Is a Greater Predictor of Cardiovascular Events in Hemodialysis Patients. BMC Nephrology, 24, Article No. 113. [Google Scholar] [CrossRef] [PubMed]
[22] Hsieh, M., Cheng, C., Chen, C., Liao, M., Lin, C., Yang, T., et al. (2022) The Association of Long-Term Blood Pressure Variability with Hemodialysis Access Thrombosis. Frontiers in Cardiovascular Medicine, 9, Article 881454. [Google Scholar] [CrossRef] [PubMed]
[23] Kovesdy, C.P. (2025) Obesity and Metabolic Health in CKD. Clinical Journal of the American Society of Nephrology, 20, 742-754.
[24] Shiina, K. (2024) Obstructive Sleep Apnea-Related Hypertension: A Review of the Literature and Clinical Management Strategy. Hypertension Research, 47, 3085-3098. [Google Scholar] [CrossRef] [PubMed]
[25] Deng, T., Xue, Y. and Methakanjanasak, N. (2026) Digital Health Integration in Chronic Kidney Disease. Clinica Chimica Acta, 582, Article ID: 120749. [Google Scholar] [CrossRef] 
[26] Hernandez, M.F. and Chang, T.I. (2023) The Need to Reduce Variability in the Study of Blood Pressure Variability. American Journal of Kidney Diseases, 81, 379-381. [Google Scholar] [CrossRef] [PubMed]
[27] 黄胜楠, 方超, 吴剑南, 等. 不同降压药物治疗原发性高血压患者血压变异的研究进展[J]. 心脏杂志, 2024, 36(4): 442-445, 451.
[28] Beimler, J. (2022) Neue Aspekte der medikamentösen Nephroprotektion. Die Innere Medizin, 63, 1200-1207. [Google Scholar] [CrossRef] [PubMed]
[29] 余谦, 蔡炜, 李勇, 等. 焦虑、抑郁对女性高血压病人血压变异性的影响[J]. 中西医结合心脑血管病杂志, 2024, 22(24): 4563-4566.

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