15 2004 10 WHO 1958 160/95 mmhg 1999 WHO 1997 (JNC)6 140/90mm Hg 1993 WHO 2 1 18 140mm Hg / 90mm Hg 2 2 2 130 mmhg / 80mm Hg 140mmHg <90mmHg 170/82mmHg 130/85mmHg (:2003 JNC7 120/80mmHg ) 130-139/85-89mmHg( JNC7 (prehypertension) 120-139/80-89 mmhg) 120/80mmHg(JNC7 ) - 1 -
Target organ damage TIA 145/90mmHg 170/105mmHg 145/90mmHg 2-3 115/75 185/115 mmhg 20/10 mmhg 130/85mmHg 35~40% 20~25% 50% ( 140~159/90 ~99 mmhg) 12mHg 10 11 9 WHO/ISH1999 JNC VI1997 mmhg mmhg <120 <80 <130 <85 130-139 85-89 140-159 90-99 160-179 100-109 180 110 ISH 140 <90 Journal Hypertension 1999; 17:162 Arch Int Med 1997; 157:2417 JNC VII2003 mmhg <120 <80 120-139 80-89 140-159 90-99 mmhg 160 100 JAMA 20032892561 1.2003 JNC7 <120/80 mmhg 120-139/80-89 mmhg prehypertension 130-139/80-89 mmhg 130/80 2 2.JNC7 WHO/ISH2003-2 -
160/110mmHg 50 5 2.5~5% 3 3 120-130/80-85mmHg 140/90mmHg (I) 1-3 TIA >55 >65 1.2~2.0mg/dl >240mg/dl LDL 160mg/dl ( ) >1.5mg/dl 300mg/day 50 HDL 40 45mg/dl ( ) WHO/ISH statement on hypertension. J Hypertension 2003; 21:198 T mmhg 140/90 1 g/d 130/80 1 g/d 125/75-3 -
~ 12~13 35 15~16 35 5-10mmHg 20mmHg 2-4mmHg Korotkoff Korotkoff 20%2002 18 25% 18 踪 - 4 -
() 1/4 720c.c. 300c.c. 60c.c. ( ) 5 45 140-149/90-94mmHg 55 65 6 12 140/90mmHg 1~2 1~2 3 6 140/90mmHg 3 130-139/85-89mmHg / - 5 -
mmhg 140-159 160-179 180 90-99mmHg 100-109mmHg 110mmHg I II 1-2 III 3 WHO/ISH statement on hypertension. J Hypertension 2003; 21: 1985 1 5% 2 酑 (Friedewald ) u QT - 6 -
CHOTGHDLc u QT 160179 180/110 100109 3 130/80(WHO/ISH) 140-159 90-99 12 140-159 90-99 1. 160/100 140-159 90-99 <140/90 140-159 90-99 <140/90 WHO / 2. WHO / ISH 140/90mmHg ISH 130/80mmHg 3.BHS IV J Hypertension 1999, 17: 168 J Human Hypertension 2004, 18: 148-7 -
( ) 1997 JNC 6 Thiazide 1999 WHO JNC 7 2004 BHS IV ( ) ( (2003 WHO/ISH ) 1 2 3 1. 6.25mg- Hydrochlorothiazide 1970~1980 50~100mg hydrochlorothiazide ( ) 25mg hydrochlorothiazide 2004 BHS (British Hypertension Society) Thiazide Hydrochlorthiazide 25mg chlorthalidone 25mg Bendroflumethiazide 5mg ( ) 15%(2004-BHS IV) 2 ACE ARB Thiazide Hydrochlorothiazide 25mg - 8 -
12.5mg Thiazide Thiazide Dihydropyridine JNC 7 2 JNC 7 JNC 6 1999 WHO/ISH 25mg Hydrochlorothiazide JNC 7 Indapamide JNC 7 ACE BHS IV 55 ACE (Loop diuretics 酑 2.5m ACE ACE hyporeninemic hypoaldosteronic hyperkalemic Syndrome Spironolactone Thiazize triamterene amiloride Spironolactone (aldosterone) (aldosterone receptor) spironolactone spironolactone (Gynecomastia) (Mastalgia) - 9 -
- 10-1 Natrilix 2 3 4 1 2 3 4
- 11 - si 5 DHP I provel micardis 1 JAMA 2003; 289:2565 G (ISA)
55 55 AB AB C D C D AB C D A B C D AACE ARBB C D thiazide Guidelines for management of hypertension BHS IV J Human Hypertension 2004, 18: 158-12 -
= Central α 2 agonists α 2 Clonidine α-methyldopa Reserpine Hydralazine Minoxidil Diazoxide Reserpineα-methyldopa Ismelin II α1 ProzosinDoxazosin Latetalol II aldosterone spironolactone ACE β I Renin Juxtaglomerular - 13 -
+ + ACE Verapamil, Verapamil, diltiazem diltiazem II ACE WHO/ISH Guidelines for Management of Hypertension, Journal Hypertension 1999, 17:169 THE JNC7 REPORT, JAMA 2003; 289: 2568. + JNC7 1999 WHO / - 14 -
ACE ARB JNC 7 JAMA 2003, 289:2568 1ACE spironolactone 9 2 P29 3BHS IV 55 ACE ACE ACE 4 JNC 7 2003 WHO/ISH 2003 2004 BHS IV JNC 7 WHO/ISH BHS IV 25mg Hydrochlorothiazide BHS IV A D A C 1999 2003 WHO/ISH The Others A C Othe others JNC 7 5 JNC 7 2004 WHO/ISH 2003 2004 BHS IV non-dihydropyridine - 15 -
ACE inhibitors ACE inhibitors Ca ACE inhibitors ACE inhibitors β Blockers non-isa ++ Channel blockers DHP Diuretics Diuretics β Blockers Ca ++ Channel blockers β Blockers Ca ++ Channel blockers non-dhp 12 ACE inhibitors Ca ++ Channel blockers 2 ACEI Diuretics ACE inhibitors β Blockers non-cardioselectiv e β Blockers Ca ++ Channel blockers amlodipine, felodipine Carvedilol β Blockers Ca ++ Channel blockers non-dhp Ca ++ Channel blockers Diltiagem, Verapamil Diuretics thiazides β Blockers - 16 -
α Blockers ACE inhibitors 3mg/dl β Blockers β Blockers β Blockers Central α agonists Reserpine 12 ( ) β Blockers β Blockers ISA Diuretics Diuretics Diuretics β Blockers Ca ++ Channel blockers non DHP Ca ++ Channel β Blockers blockers Carvedilol amlodipine felodipine ACE inhibitors ACE inhibitors Angiotension II antagonists Angiotension II antagonists α-methyldopa Labetalol Potassium sparing agents ARCH INTERN MED. 1997; 157:2428 ISA=Intrinsic Sympathomimetic activity, DHP=Dihydropyridines UK Prospective Diabetes study, 1148 ACE β 144/82mmHg 154/87mmHg 1/3 1/2 1/2-17 -
2. ACE II aldosterone ACE (angiotensin I) II Kininase Bradykinin 15-20% angioedema Bosmin(Epinephrine) Capoten ACE ARB ACE ( ) 2 4 1 2 30 55 3 4 5 30% ACE II ACE ACE 3. 2 (ARB,Angiotensin-recepter blocker) ACE ACE I 酶 (ACE) II (Renin-angiotensin system) ARB ACE ARB ARB ACE 4. Raynaud verapamil diltiazem - 18 -
1995 Pasty Furberg nifedipine Opie Messerli Pasty Furberg 16 Nifedipine 80mg ( ) verapamil Diltiazem Verapamil Verapamil WPW Verapamil 5. (Rebound tachycardia) Raynaud s ACE ARB Thiazide 6. 1 Doxazosin 3 2 prazosin Guanethedine (Ismelin) 10 ~20mmHg 7. Hydralazine - 19 -
Reserpine Minoxidil Sodium nitropruside 8. (1) α 2 ClonidineMethyldopa Guanfacine Clonidine Clonidine (2) ReserpineGuanethidine (Ismelin) Reserpine 0.25mg 0.05-0.125mg depression methyldopa GuanethidineReserpine Clonidine 1999 2003 WHO/ISH ~ 1. 2. JNC7 20/10 mmhg Thiazide P15 Thiazide JNC6 3. 24 4. - 20 -
2 ( ) WHO/ISH Journal Hypertension 1999, 17:172 European Society of Hypertension Journal Hypertension 2003, 21:1033 1. 1999 2003 WHO/ISH Reserpineguanethidine (Ismelin)Clonidine α-methyldopa 2. BHS IV Thiazde 3. - 21 -
(1999 WHO/ISH) 2004 BHS IV ACE 55 Indapamide Indapamide ACE 55 Dihydropyridine / Verapamil Propranolol ACE Thiazide Indapamide ACD A+C+I ACE A+C+O Reserpine GuanethedineClonidine -Methyldopa O 1999 2003 WHO/ISH ACE A+B+C IIndapamide 55 A D C 55 C O B AACE ARB B C D IIndapamide Oothers - 22 -
Verapamil Propranolol 3 140/90mmHg 160mmHg 1. aspirin( 75mg) aspirin HOT 50 aspiri aspirin aspirin aspirin 2. / CHO TG 1 VLDL 2 LDL 3 HDL Total c HDL c LDL c VLDL c TG/5 ATP III 20 5 Total c TG HDL c LDL c ATP III ATP II ATP II LDL c Friedewald LDL c Total c HDL c VLDL c TG/5 LDL c 1999 Guidelines for the management of patients with chronic stable angina CalculateLDL c TG400 mg% LDL c - 23 -
[ ( adolsteronism (pheochromocytoma) ) ] codeine erythropoietin cyclosporins Nasal decongestants THE JNC 7 REPORT JAMA 2003, 289:2569 2 TC 200mg/dl 200mg/dl TC 240mg/dl 240mg/dl 130mg/dl 130mg/dl LDL-C 160mg/dl 160mg/dl TG 200mg/dl TC/HDL-C5 200mg/dl HDL-C40mg/dl TC 200mg/dl 160mg/dl LDL-C 130mg/dl 100mg/dl TG 200mg/dl TC/HDL5 150mg/dl HDL-C40mg/dl 500mg/dl 1. 2. 45 3. 4. 55-24 -
LDL c 9499 TG LDL c LDL c Total c HDL c LDL c VLDL c TG/5 TG LDL c /HDL c Friedewald 20 13 LDL c LDL c LDL c Framingham ATP III 2 2 1020 20 100 10 20 01 10 ATP II III 3 ATP 1 2 140/90 mmhg3hdl c 40 mg/dl 60mg/dl 4 55 65 5 45 55 HDL c Framingham ATP A 1LDLc 130mg/dl CHO 200mg/dl Statins LDL c 100mg/dl CHO 160 mg/dl 2LDL c 100129 mg/dltg HDL c fibric acid LDL c 24 48 LDL c LDL c LDL c 100mg/dl B 2 C 01 3 ( ) 2 LDL c 130 mg/dl ( ) 2 LDL c 160 mg/dl - 25 -
LDL c 130 mg/dl LDL c 160 mg/dl CHO 240 mg/dl 3 6 3 2 3 LDL c 190 mg/dl Statins Bile acid sequestrants LDL c Statins LDL c 1855 Statin 1 2 4 ATP III 1 ( 3 6 ) Statins 酶 GPT 3 312 酶 Statins Bile acid sequestrant Cholestyramine Questran LDL c 1530 TG 200 mg/dl TG 500 mg/dl fibric acid TG 200499 mg/dl ATP III LDL c 3 HDL c TG 2 HDL c 40 mg/dl Total c /HDL c 5 HDL c 35 40 5 35/404.38 4.38 HDL c Total c HDL c LDL c VLDL c TG/5 ATP III TG 200 mg/dl HDL c 130 mg/dl ATP III HDL c 130 mg/dl LDL c 100 mg/dl TG 150/5 TG 200 mg/dl, 01 ATP III HDL c 2 3 190 mg/dl HDL c 190 mg/dl 2 HDL c 2 3 160 mg/dl - 26 -
160 mg/dl TG 200mg/dl TG 150mg/dl fibric aid 2050 Nicotinic acid TG 2050 / TG TG HDL C TG TG TG fatty liver VLDL IDL 50 LDLVLDL HDL c trans fatty acid LDL C LDL C NCEP 7 LDL C LDL C 200 300 HDL C LDL C - 27 -
3. 1 2 ACE-I ARB 1 125/75mmHg 130/80mmHg 3 3 ACE-I ARB 2.5mg Thiazide loop loop diuretics 4. 1.5 2 2 80% 2 2 insulin resistant state Syndrome X HDL ATP 3 metabolic syndrome 130/85 mmhg ( 110mg/dl ( 88 77 ) 40mg/dl) ACE-I ARB ARB HOT 80mmHg 130/80 mmhg ACE-IARB Thiazide HbA1C 7% 5. ACE ARB ACE ARB Hydralazine minoxidil - 28 -
ACE ARB 6. (ISA ) ( ) (ISA)ACE ACE aspirin 7. Framingham ( ) (idiopathic dilated cardiomyopathy) ACE / ACE (ARB ) 1 (CarvedilolBisoprolol Metoprolol) ( ) ACE ACE Hydralazine Isosorbide dinitrate ACE ARB Dihydropyridine amlodipine ACC/AHA Guidelines for the management of HF 2001Felodipine ACE / Arch Intern Med/Vol 157,Nov 24,1997 BP>140/90mmHg 10mmHg 90mmHg 3 1 25mmHg 15mmHg 8-10% 1. 2. : pre-eclampsia - 29 -
20 3. 170/110mmHg ( ) nifedipinelabetalol hydralazine magnesium sulfate oxprenololpindololatenolol labetalolmethyldopaprazosinhydralazinenifedipine isradipine ACE II α 2 methyldopac atenololc metoprololc labetalolc C ACE D II hydralazine Arch Intern Med. 1997; 157:2434 FDA C D - 30 -
2002 Framingham 55 90 160/95mmHg 50% 60 140/90mmHg 70% 65 65% JNC7 50 140 mmhg 80 (Baroreceptor) 7% 20% ( ) ( ) Dihydropyridine ACE ARB prazosin Tamsulosin 15% - 31 -
1 2 3NCEP Adult Treatment Panel II Circulation 1994; 89:1333-1345 4JNC6 Prevention, Detection, Eualuation, and Treatment of High Blood Pressure. Arch Intern Med. 1997; 157:2413-2446 51999 WHO/ISH Hypertersion Guidelines for Management of Hypertension, Journal of Hypertension 1999; 17:151-183 6 72003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension Journal of Hypertension 2003211011-1053 8Detection,evaluation,and treatment of High Blood Pressure(JNC 7) JAMA 20032892560-2572 92003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension J of Hypertens 2003211983-1992 British Hypertension Society Guidelines for management of hypertension J Human Hypertension 200418139-185 - 32 -