慢性肾脏病高血压联合降压：自由联合 还是固定配方制剂？
Free combination or fixed-dose combination agents against hypertension with chronic kidney disease?

慢性肾脏病（CKD）患者的血压达标是＜130/80 mmHg，常常需要2种或者以上的抗高血压药物联合 使用，而且CKD患者降低血压的同时还需要减少蛋白尿以带来肾脏获益。目前市场上有固定的联合降压药物，也 可以根据医生处方进行自由联合，然而2018年欧洲高血压指南推荐优先选择固定配方的降压药物。这个建议是否 适合CKD患者值得探讨。
The target of antihypertension in the patients with chronic kidney disease (CKD) and hypertension is less than 130/80 mmHg, which is usually realized by the combined use of two or more antihypertensive medications. Furthermore, the reduction of blood pressure should be accompanied by the decrease of proteinuria to maximize the potential benefits to the kidney. There are some fixed-dose antihypertension medications in the current market. The patients can choose free combination medications according to doctors’ suggestions as well. However, 2018 ESC/ESH Guidelines for the management of arterial hypertension suggest choosing fixed-dose combination agents firstly. It is necessary to discuss whether the suggestion is suitable for CKD