Angiotensin converting enzyme inhibitor ACEI Angiotensin receptor blocker ARB Body mass index BMI Calcium channel blocker CCB Coronary heart disease C

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2 Angiotensin converting enzyme inhibitor ACEI Angiotensin receptor blocker ARB Body mass index BMI Calcium channel blocker CCB Coronary heart disease CHD Dietary approach to stop hypertension DASH Diastolic blood pressure DBP High-density lipoprotein cholesterol HDL-C Low-density lipoprotein cholesterol LDL-C Monoamine oxidase MAO Nonsteroid anti-inflammatory drug NSAID Systolic blood pressure SBP The Seventh Report of the Joint National Committee JNC 7 on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Total cholesterol TC Triglyceride TG Aldosterone antagonist Ambulatory blood pressure monitoring Aneurysm Antecubital fossa Angioedema Angiotensin converting enzyme inhibitor (ACEI) Angiotensin receptor blocker (ARB) Autonomic dysfunction Bioavailability Body mass index (BMI) Brachial pulse -agonist -blocker Catecholamine 1

3 Calcium channel blocker (CCB) Coronary heart disease (CHD) Corticotropin (ACTH) Conn's syndrome Cyclosporine Diastolic blood pressure (DBP) Dietary approach to stop hypertension (DASH) trial Doppler Dopamine Ductus arteriosus Erythropoietin (EPO) Episodic hypertension Epinephrine First dose effect Framingham study High-density lipoprotein cholesterol (HDL-C) Intrinsic sympathomimetic effect Isolated systolic hypertension Licorice Low-density lipoprotein cholesterol (LDL-C) Microalbuminuria Mineralocorticosteroid Monoamine oxidase (MAO) inhibitors Nonsteroid anti-inflammatory drug (NSAID) Norepinephrine Phase 1 Phase 5 Prehypertension Renin Systolic blood pressure (SBP) Target organ Total cholesterol (TC) Triglyceride (TG) Tyramine White-coat hypertension Withdrawal syndrome 2

4 - WHO ISH Guideline,1999 7JNC

5 %18.2% % 40%25%50% %79% 47%64%21% 29% 4

6 contents

7

8 40%25%50% (1) (2) (3) (4) (5) angiotensin receptor blocker (6) (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the JNC 7) (1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension & ESH Updates) 7

9 (1) 120/80 mmhg130/85 mmhg mmhg8089 mmhg (2) 115/75 mmhg 20/10 mmhg (3) (140 mmhg) (4) DASH (5) thiazide (6) 8

10 140/90 mmhg 130/80 mmhg 20/10 mmhg thiazide (1) (2) (3) 9

11 JNC mmhg/(diastolic blood pressure, DBP)90 mmhg 120 mmhg80 mmhg prehypertension2-1jnc mmhg /90-99 mmhg 160 mmhg/100 mmhg (mmhg) (mmhg) <120 <80 (prehypertension)

12 2-2 (90-94) (95-99) (99) (SBP) SBP DBP SBP DBP SBP DBP SBP DBP SBP DBP SBP DBP Systolic blood pressure, SBPDiastolic blood pressure, DBPmmHg 11

13 210/120 mmhg /80 mmhg JNC 7 115/75 mmhg20 mmhg10 mmhg 12

14 2-1 96% JNC %19% %18.2%

15 %

16 圖2-2 15歲以上國人收縮壓之年齡趨勢 來源 國民健康局2002年調查資料 圖2-3 15歲以上國人舒張壓之年齡趨勢 來源 國民健康局2002年調查資料 圖2-4 <20 15歲以上國人之高血壓盛行率年齡分佈 年 齡 來源 國民健康局2002年調查資料 15

17 140 mmhg90 mmhg ( mmhg mmhg) () 16

18 二 儀器 圖3-1 水銀柱式的血壓計比指針式的血壓計來得可靠 然而水銀柱血壓計 如果不善加保養使用 也會發生誤差 所以血壓計每隔半年至一年 最 好能校正一次 電子血壓計雖然十分方便 但它們測量出錯時 不像水 銀柱血壓計一樣容易發現及校正 使用時應特別注意 壓脈帶(cuff)的大小有絕對的重要性 標準的壓脈帶寬約12.5公分 且必須長到足夠環繞上臂 壓脈帶的寬度是依年齡及病患肥胖度而決定 (見表3-1) 另外 必須注意內袋(inner bag)的大小 其寬度必須超過上 臂長度的三分之二 且其周長必須超過上臂周長的80% 表3-1 壓脈帶寬度的建議值 受測者 壓脈帶寬度 1歲以下 2.5公分 1-3歲 5-6公分 4-8歲 9-10公分 一般成人 12.5公分 肥胖成人 14公分 圖3-1 血壓計 電子式血壓計 氣壓表式血壓計 水銀柱式血壓計 17

19 (2 ) (antecubital fossa) (brachial pulse)(3-2) 20~30 mmhg2~3 mmhg (phase 1) (phase 5) Nicolai S. Korotkoff1905 (muffling) 2~3 5 mmhg 18

20 (210 mmhg120 mmhg) * (mmhg) * < 120 < * 19

21 (ambulatory blood pressure monitoring) % white-coat hypertension episodic hypertension autonomic dysfunction 135/85 mmhg 20

22 115/75 mmhg185/115 mmhg20 mmhg 10 mmhg mmhg90-99 mmhg 12 mmhg Framingham Study mmhg isolated systolic hypertension coronary heart disease, CHD CHD CHDCHD 21

23 5 mmhg 140/90 mmhg JNC %53% 31%45% 22

24 15%22% %79% 47%64%21% 29% 23

25

26

27

28 (A) (B)(C) (1) 30g 27

29 15 mmhg 710 mmhg (2) (licorice)carbenoxolone ( ) (mineralocorticosteroid) (3) (corticotropin, ACTH) (4) (nonsteroid anti-inflammatory drug, NSAID)indomethacin (5) phenylpropanolamine (catecholamine) (MAO inhibitor)pargyline (tyramine) 3. 28

30 4. ductus arteriosus 5. Conn's syndrome 29

31 () () ()(target organ)(5-2) 5-2 (target organ) 50% aneurysm 1.5 mg/dl 1(+) microalbuminuria 30

32 (cyclosporine)(erythropoietin, EPO) (MAO inhibitor) 31

33

34

35 5-3 (1) (2) X (3) (catecholamine) 1. 34

36 (1) Sokolow-LyonV5V6 RV1S35(mV) (2) (3) (4) (5) 35

37 (6) (7) (8) (1) (Doppler) 36

38 (2) (renin) 24(catecholamine) (norepinephrine) (epinephrine)(dopamine) 37

39 2003JNC * (BMI ) mmhg DASH mmhg 2.4 g 28 mmhg (6 g) 49 mmhg cc 24 mmhg 15 cc(30cc720cc 300 cc60cc) * ) 1 BMI[()]/[()] 2 2 DASHDietary Approach to Stop Hypertension, 2100/ 38

40 (body mass index, BMI) BMI BMI18.5~ BMI30 BMI BMI BMI BMI BMI (Body Mass Index) () () 2 () 2 22 ( 10%)

41 6-2.2 (BMI) ()

42

43 BMI 10% Dietary Approach to Stop Hypertension trial, DASH trial DASH6-3 DASH

44 6-3 DASH *DASH DASH 1. / / / / / / / *

45 6-4 DASH oz oz 1 1/ oz 1 1% 1.5 oz 2 3 oz oz 1/32 DASH 44

46 10 mmhg ()() ()() () A () ()

47 6-6 (/100) () () 6-7 () ()

48 () /

49 11 mmhg JNC

50 ()/ 100 (100)

51

52 /56 1/ / /52 51

53 /6080% 10 mmhg JNC

54 g/kg 30 cc 30 cc720 cc300 cc200 cc 60 cc60 cc 30 cc cccc. 30 cc(cc.) 16.50% % % % % % % 90 54% % %

55 withdrawal syndrome

56 55

57 JNC 7 140/90 mmhg 140/90 mmhg 130/80 mmhg

58 7-1 (<140/90 mmhg <130/80mmHg ( mmhg mmhg) thiazide ACEI, ARB, -blockers, CCB ( 160 mmhg thiazide ACEI ARBblockers, CCB (ACEI, ARB, diuretics, - blockers, CCB mmhg 90~99 mmhg 57

59 160 mmhg100 mmhg angiotensin converting enzyme inhibitor, ACEIangiotensin receptor blocker, ARB -blockercalcium channel blocker, CCBthiazide Class- Drug (Trade Name)-() Usual Dose Range Daily mg/d- Frequency- Thiazide diuretics Chlorothiazide (Diuril) Chlorthalidone (generic) Hydrochlorothiazide(Microzide, HydroDIURIL)+ Polythiazide(Renese) Indapamide(Lozol, Natrilix) Metolazone(Mykrox) Metolazone(Zaroxolyn) Loop diuretics Bumetanide(Bumex, Burinex) Furosemide(Lasix) Torsemide(Demadex)

60 Potassium- Amiloride(Midamor) sparing diuretics Triamterene(Dyrenium) Aldosterone- Eplerenone(Inspra) receptor blockers Spironolactone(Aldactone) Blockers Atenolol(Tenormin) Betaxolol(Kerlone) Bisoprolol(Zebeta) Metoprolol(Lopressor, Betaloc) Metoprolol extended release (Toprol XL) Nadolol(Corgard) Propranolol(inderal) Propranolol long-acting(inderalla) Timolol(Blocadren) Blockers with Acebutolol(Sectral) intrinsic sympathomimetic activity Penbutolol(Levatol) Pindolol(generic) Combined Carvedilol(Coreg, Dilatrend) and-blockers Labetalol(Normodyne, Trandate)

61 ACE inhibitors Benazepril(Lotensin) Captopril(Capoten) Enalapril(Vasotec, Renitec) Fosinopril(Monopril) Lisinopril(Prinivil, Zestril) Moexipril(Univasc) Perindopril(Aceon) Quinapril(Accupril) Ramipril(Altace, Tritace) Trandolapril(Mavik) Angiotensin P Candesartan(Atacand Blopress) receptor blocker Eprosartan(Tevetan) Irbesartan(Aprovel) Losartan(Cozaar) Olmesartan(Benicar) Telmisartan(Micardis) Valsartan(Diovan) Calcium channel Diltiazem extened release( blockers- non- dihydropyridines Cardizem CD, Dilacor XR, Tiazact)+ Diltiazem extended release( Cardizem LA) Verapamil immediate release( Calan, Isoptin)+ Verapamil long-acting(calan SR, Isoptin SR)+ Verapamil-coer(Covera HS, Verelan PM) 60

62 Calcium channel Amlodipine(Norvasc) blockers- Felodipine(Plendil) dihydropyridines Isradipine(Dynacirc CR) Nicardipine sustained release (Cardene SR) Nifedipine long-acting (Adalat CC, Procardia XL) Nisoldipine(Sular) Blockers Doxazosin(Cardura, Doxaben) Prazosin(Minipress) Terazosin(Hytrin) Central 2 - Clonidine(Catapres) agonists and Clonidine patch(catapres TTS) weekly other centrally acting drugs Methyldopa(Aldomet) Reserpine(generic) # Guanfacine(generic) Direct Hydralazine(Apresoline) vasodilators Minoxidil(Loniten) Abbreviation: ACE, angiotensin-converting enzyme. * Dosages may vary from those listed in the Physicians Desk Reference. Which may be consulted for additional information. + Are now or will soon become available in generic preparations. # A 0-1 mg dose may be given every other day to achieve this dosage. 61

63 7-2 Thiazides Loop diuretics thiazides Potassium- ACENSAID sparing agents Spironolactone Triamterene Amiloride () Acebutolol Atenolol Betaxolol Bisoprolol Carteolol HDL(pindolol Metoprolol acetbutolol) Pindolol Propranolol Timolol (-1-) Prazosin (first doseeffect) Terazosin 62

64 () Labetalol Vasodilators Hydralazine Antinuclear antibody(ana) Minoxidil Captopril Cilazapril Enalapril Fosinopril Lisinopril Quinapril Candesartan Eprosartan Irbesartan 63

65 Losartan Olmesartan Telmisartan Valsartan () () ( ) Verapamil Diltiazem Nifedipine Nicardipine Felodipine Amlodipine Isradipine Clonidine - Methyldopa clonidine catecholamine Guanabenz Guanfacine 64

66 Guanadrel sulfate Guanethidine monosulfate Rauwolfia alkaloids Reserpine 7-3 Cholestyraminecolestipol Aldosterone thiazides furosemide NSAID(aspirin ) NSAID- Cimetidine diltiazemverapamil Rifampinphenobarbital Quinidine reserpine 65

67 theophyllinelidocaine chlorpro-mazine ( phenylpropanolamine ephedrinepseudoephedrine )epine-phrine ( receptor ) - () ACE NSAID(aspirin) ACE NSAID () ACE (bioavailability) 66

68 NSAID(aspirin) ( NSAID ) Cimetidine Verapamildigoxin carbamazepine rifampinverapamil diltiazem carbamazepinediltiazem verapamilphenobarbital Verapamil phenytoinverapamil prazosintheophylline Cyclosporine guanethidine ephedrineamphetamine clonidine Methyldopa phenothiazine Monoamine oxidase inhibitors (MAO) tyramine 67

69 norepinephrine reserpine guanethidine clonidineguanabenz thiazide thiazide () thiazide Treatment to Prevent Heart Attack trial Anti-Hypertension and Lipid-lowering trialthiazide The Second Australian National Blood Pressure trial ACE 68

70 thiazide thiazideacei ARB-blockerCCB () ACE 69

71 () 20/10 mmhg Combination Type Fixed-Dose Combination, mg* Trade Name ACE inhibitors and Amlodipine/benazepril hydrochloride(2.5/10,5/10,5 Lotrel CCBs /20,10/20) Enalapril maleate/felodipine (5/5) Trandolapril/verapamil (2/180,1/240,2/240,4/240) Lexxel Tarka ACE inhibitors and Benazepril/hydrochlorothiazide (5/6.25,10/12.5,50/ Lotensin HCT diuretics 15,50/25) Captopril/hydrochlorothiazide (25/15,25/25,50/15, Capozide 50/25) Enalapril maleate/hydrochlorothiazide (5/12.5,10/25) Vaseretic Lisinopril/hydrochlorothiazide (5/12.5,20/12.5,20/25) Moexipril HCI/hydrochlorothiazide (7.5/12.5,15/25) Quinapril HCI/hydrochlorothiazide (10/12.5,20/12.5, Prinzide Uniretic Accuretic 20/25) ARBs and diuretics Candesartan cilexetil/hydrochlorothiazide (16/12.5,32 Atacand HCT /12.5) Eposartan cilexetil/hydrochlorothiazide (600/12.5,600 Teveten HCT 70

72 /25) Irbesartan/hydrochlorothiazide (75/12.5,150/12.5,300 Avalide /12.5) Losartan potassium/hydrochlorothiazide (50/12.5,100 Hyzaar /25) Telmisartan/hydrochlorothiazide (40/12.5,80/12.5) Valsartan/hydrochlorothiazide (80/12.5,160/12.5) Micardis HCT Diovan HCT -Blockers and Atenolol/chlorthalidone (50/25,100/25) Tenoreic diuretics Bisoprolol fumarate/hydrochlorothiazide (2.5/6.25,5/ Ziac /6.25) Propranolol tartrate/hydrochlorothiazide (40/25,80/25) Metoprolol tartrate/hydrochlorothiazide (50/25,100/25) Nadolol/bendrofluthiazide (40/5,80/5) Timolol maleate/hydrochlorothiazide (10/25) Inderide Lopressor HCT Cozide Timolide Centrally acting Amiloride HCI/hydrochlorothiazide (250/15,250/25, Aldoril grug and diuretic 500/30,500/50) Reserpine/chlorothiazide (0.125/250,0.25/500) Reserpine/hydrochlothiazide Diupres Hydropres Diuretic and diuretic Amiloride HCI/hydrochlorothiazide (5/50) Moduretic Spironolactone/hydrochlorothiazide (25/25,50/50) Triamterene/hydrochlorothiazide (37.5/25,50/25,75 Aldactone Dyazide. /50) Maxzide Abbreviations:ACE angiotensin-converting enzyme:arb, angiotensin-receptor blocker,ccb,calcium channel blocker,hci,hydrochloride,hct,hydrochlorothiazide,la, longacting. * Some drug combinations are available in multiple fixed doses. Each drug dose is reported in milligrams. 71

73 () (serum potassiumk) (creatininecr) Aspirin

74 7-6 (1) (2) a. b. c. d. NSAID (3) (4) (5) 30 cc 73

75 140 mmhg90 mmhg guanethidineguanadrel-1labetalol 95 (Doppler) 74

76 ACE 23 75

77 (1) (2) (3) (4) 140/90 mmhg 30 mmhg15 mmhg 140/90 mmhg 6 mg/dl 1. ACE methyldopa ACE 2. 76

78 100 mmhg methyldopa hydralazine-- hydralazine furosemide nifedipineclonidine 77

79 >220 mmhg>120 mmhg 220 mmhg120 mmhg 1015%ACE thiazide ACE ACE 78

80 ACE loop ACE hydralazineminoxidil 79

81 ACE ACE 130/80 mmhg -1 /ACE -- phenylpropanolamine guanethidinereserpine 80

82 agonist total cholesterol, TC high-density lipoprotein cholesterol, HDL-C low-density lipoprotein cholesterol, LDL-C triglyceride, TG8-1 ThiazideloopLDL-C HDL-C intrinsic sympathomimetic effect labetalol -1- LDL-C ACE 81

83 ( ) 200 mg/dl TC 240 mg/dl LDL- 130 mg/dl C 160 mg/dl TG200 mg/dl ( TC/HDL-C5 HDL-C40 mg/dl) TC200 mg/dl LDL-C130 mg/dl TG200 mg/dl ( TC/HDL-C5 HDL-C40 mg/dl) =( ) V X V X X X X X TC/HDL-C 5HDL-C 40 mg/dl 1. (1) (2) (3) 2. (1) (2) (3) 70% X X X X V X X V 200 mg/dl 240 mg/dl 130 mg/dl 160 mg/dl 200 mg/dl (87/4/1) 160 mg/dl (87/7/1) 100 mg/dl (87/7/1) 150 mg/dl (87/7/1) 1000 mg/dl(87/4/1) 82

84 Thiazide (:allopurinol) (probenecid) thiazide (1) 60 ml/min/1.73 m 2 (1.5 mg/dl1.3 mg/dl)(2) 300 mg200 mg/gm 130/80 mmhg ACE 35 ACE 30 ml/min/1.73 m 2 ( mg/dl)loop 83

85 (30) ( 9080BMI24)( 110 mg/dl)130/85 mmhg( 150 mg/dl)(40 mg/dl 50 mg/dl) 10 mmhg (-) (norepinephrine) 84

86 -(phentolamine) ( ) (Cyclosporine) 5070 labetalolclonidine diltiazemnicardipineverapamil 85

87 (7-2) Thiazide () Raynaud - Thiazide ACE ACE (angioedema)5 meq/l 86

88 87 () ( mmhg80-89 mmhg) JNC 7 5 mmhg 14%9%7% (1) (2) (3)() (4)

89 (5) (6) (1)() ( ) 88

90 (2) () () () 89

91 90

92 1. American Diabetes Association. Treatment of hypertension in adults with diabetes. Diabetes Care. 2003;26(suppl 1):S80-S Black HR, Elliott WJ, Grandits G, et al. Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. JAMA. 2003;289: Blood Pressure Lowering Treatment Trialists Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressurelowering drugs: results of prospectively designed overviews of randomized trials. Lancet. 2000;256: Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345: Chien KL, Sung FC, Hsu HC, Su TC, Lee YT. Left ventricular mass and correlated atherosclerotic risk factors in young adolescents: report from Chin-Shan community cardiovascular study in Taiwan. Atherosclerosis. 2001;155: Chobanian AV, Bakris GL, Black HR, et al. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42: Chobanian AV, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, 91

93 Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289: Dahlof B, Devereux RB, Kjeldsen SE. et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE). Lancet. 2002;359: Guidelines Subcommittee: 1999 World Health Organization- International Society of Hypertension guidelines for the management of hypertension. J Hypertens. 1999;17: Guidelines Committee European Society of Hypertension- European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21: Kjeldsen SE, Erdine S, Farsang C, Sleight P, Mancia G; 1999 WHO/ISH Hypertension Guidelines subcommittee WHO/ISH Hypertension Guidelines--highlights & ESH update. J Hypertens. 2002;20: Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortaility. Lancet. 2002;360: Lee YT, Lin RS, Sung FC, Yang CY, Chien KL, Chen WJ, Su TC, Hsu HC, Huang YC. Chin-Shan Community Cardiovascular Cohort in Taiwan-baseline data and five-year follow-up morbidity and mortality. J Clin Epidemiol. 2000;53: Lewis WJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with 92

94 nephropathy due to type 2 diabetes. N Engl J Med. 2001;345: National Kidney Foundation Guideline. K/DOQI clinical practice guidelines for chronic kidney disease: kidney Disease Outcome Quality Initiative. Am J Kidney Dis. 2002;39(suppl 2):S1-S National Cholesterol Education Program. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106: National High Blood Pressure Education Program. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183:S1-S National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 Task Force Report on high blood pressure in children and adolescents. Pediatrics. 1996;98: Pan WH, Chang HY, Yeh WT, Hsiao SY, Hung YT. Prevalence, awareness, treatment and control of hypertension in Taiwan: results of Nutrition and Health Survey in Taiwan (NAHSIT) J Hum Hypertens. 2001;15: Pitt B, Remme W, Zannad F. et al. Eplerenone a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348: Sacks FM, Svetkey LP, Vollmer WM, et al, for the DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension 93

95 (DASH) diet. N Engl J Med. 2001;344; Su TC, Jeng JS, Chien KL, Sung FC, Hsu HC, Lee YT. Hypertension status is the major determinant of carotid atherosclerosis: a community-based study in Taiwan. Stroke. 2001;32: The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angio-tensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA. 2002;288: The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor. ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342: The Capricorn Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomized trial. Lancet. 2001;357: Torng PL, Su TC, Sung FC, Chien KL, Huang SC, Chow SN, Lee YT. Effects of menopause on intraindividual changes in serum lipids, blood pressure, and body weight--the Chin-Shan Community Cardiovascular Cohort study. Atherosclerosis. 2002; 161: UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. BMJ 1998;317: Vasan RS, Larson MG, Leip EP, et al. Assessment of frequency of progression to hypertension in non-hypertensive participants in The Framingham Heart Study. Lancet. 2001;358: Verdecchia P. Prognostic value of ambulatory blood pressure. Hypertension. 2000;35:

96 30. Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288; Wang TD, Chen WJ, Chien KL, Seh-Yi Su SS, Hsu HC, Chen MF, Liau CS, Lee YT. Efficacy of cholesterol levels and ratios in predicting future coronary heart disease in a Chinese population. Am J Cardiol. 2001;88: Wing LMH, Reid CM, Ryan P, et al, for Second Australian National Blood Pressure Study Group. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med. 2003;348: World Health Organization, International Society of Hypertension Writing Group World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21: Wright JT Jr. Agodoa L, Contreras G. et al. Successful blood pressure control in the African American Study of Kidney Disease and Hypertension. Arch Intern Med. 2002;162:

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