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

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

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

- WHO ISH Guideline,1999 7JNC72003 3

2002 1524.9%18.2%65 56.6% 40%25%50% 2002 59%79% 47%64%21% 29% 4

contents.................................................1...............................................1...............................3.................................................4...............................................6.......................10.........................................16............................21..............................24.........................38....................................56...........................74.87............................90.......................................91 5

147.7 156.81-1 152.9 152.3 1-1 6

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

(1) 120/80 mmhg130/85 mmhg120139 mmhg8089 mmhg (2) 115/75 mmhg 20/10 mmhg (3) (140 mmhg) (4) DASH (5) thiazide (6) 8

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

JNC 72003 140 mmhg/(diastolic blood pressure, DBP)90 mmhg 120 mmhg80 mmhg prehypertension2-1jnc 7 140-159 mmhg /90-99 mmhg 160 mmhg/100 mmhg 2-1 18 (mmhg) (mmhg) <120 <80 (prehypertension) 120-139 80-89 140-159 90-99 160 100 952-2 10

2-2 (90-94) (95-99) (99) (SBP) 7 96-105 106 8-30 104-109 110 2 SBP 104-111 112-117 118 DBP 70-73 74-81 82 3-5 SBP 108-115 116-123 124 DBP 70-75 76-83 84 6-9 SBP 114-121 122-129 130 DBP 74-77 78-85 86 10-12 SBP 122-125 126-133 134 DBP 78-81 82-89 90 13-15 SBP 130-135 136-143 144 DBP 80-85 86-91 92 16-18 SBP 136-141 142-149 150 DBP 84-91 92-97 98 Systolic blood pressure, SBPDiastolic blood pressure, DBPmmHg 11

210/120 mmhg 10 23 2-1 120/80 mmhg JNC 7 115/75 mmhg20 mmhg10 mmhg 12

2-1 96% JNC 75000 10 1993-1996 26%19% 200215 24.9%18.2% 2002183030 60 2-2 13

30602-3 1989-199165 36.9 200265 56.6% 40 60 200260 602-4 1990 1993-1996 46 14

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 20-29 30-39 40-49 年 50-59 60-69 70-79 80+ 齡 來源 國民健康局2002年調查資料 15

140 mmhg90 mmhg (120-139 mmhg 80-89 mmhg) () 16

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

(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

3-2 21 (210 mmhg120 mmhg) 3-2 3-2 18* (mmhg) * < 120 < 80 120-139 80-89 140-159 90-99 160-179 100-109 180 110 * 19

(ambulatory blood pressure monitoring)3-3 3-3 10-20% white-coat hypertension episodic hypertension autonomic dysfunction 135/85 mmhg 20

115/75 mmhg185/115 mmhg20 mmhg 10 mmhg 140-159 mmhg90-99 mmhg 12 mmhg Framingham Study 50140 mmhg isolated systolic hypertension coronary heart disease, CHD CHD CHDCHD 21

5 mmhg 140/90 mmhg 1999-2000JNC 7 19931996 43%53% 31%45% 22

15%22%2002 59%79% 47%64%21% 29% 23

9699 5-1 24

1 2 3 4 1. 2. 14 25

52.5 62.4 3. 4. 5. 6. 26

5-1 1. 2. (A) (B)(C) (1) 30g 27

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

4. ductus arteriosus 5. Conn's syndrome 29

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

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

1. 2. 32

3. 5-3 33

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

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

(6) (7) (8) 2. 3. (1) (Doppler) 36

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

2003JNC 7 6-1 6-1 * (BMI 1 18.523.9) 10 520 mmhg DASH 2 810 mmhg 2.4 g 28 mmhg (6 g) 49 mmhg 330 30cc 24 mmhg 15 cc(30cc720cc 300 cc60cc) * ) 1 BMI[()]/[()] 2 2 DASHDietary Approach to Stop Hypertension, 2100/ 38

(body mass index, BMI) BMI BMI18.5~23.9 18.52427 3035BMI30 BMI BMI BMI6-2.16-2.2 6-2.1 BMI BMI (Body Mass Index) () () 2 () 2 22 ( 10%) 90 80 39

6-2.2 (BMI) () 150 41.6 41.654.0 54.0 60.8 67.5 78.8 151 42.2 42.254.7 54.7 61.6 68.4 79.8 152 42.7 42.755.4 55.4 62.4 69.3 80.9 153 43.3 43.356.2 56.2 63.2 70.2 82.0 154 43.9 43.956.9 56.9 64.0 71.1 83.0 155 44.4 44.457.7 57.7 64.9 72.1 84.1 156 45.0 45.058.4 58.4 65.7 73.0 85.2 157 45.6 45.659.2 59.2 66.6 73.9 86.3 158 46.2 46.259.9 59.9 67.4 74.9 87.4 159 46.8 46.860.7 60.7 68.3 75.8 88.5 160 47.4 47.461.4 61.4 69.1 76.8 89.6 161 48.0 48.062.2 62.2 70.0 77.8 90.7 162 48.6 48.663.0 63.0 70.9 78.7 91.9 163 49.2 49.263.8 63.8 71.7 79.7 93.0 164 49.8 49.864.6 64.6 72.6 80.7 94.1 165 50.4 50.465.3 65.3 73.5 81.7 95.3 166 51.0 51.066.1 66.1 74.4 82.7 96.4 40

167 51.6 51.666.9 66.9 75.3 83.7 97.6 168 52.2 52.267.7 67.7 76.2 84.7 98.8 169 52.8 52.868.5 68.5 77.1 85.7 100.0 170 53.5 53.569.4 69.4 78.0 86.7 101.2 171 54.1 54.170.2 70.2 79.0 87.7 102.3 172 54.7 54.771.0 71.0 79.9 88.8 103.5 173 55.4 55.471.8 71.8 80.8 89.8 104.8 174 56.0 56.072.7 72.7 81.7 90.8 106.0 175 56.7 56.773.5 73.5 82.7 91.9 107.2 176 57.3 57.374.3 74.3 83.6 92.9 108.4 177 58.0 58.075.2 75.2 84.6 94.0 109.7 178 58.6 58.676.0 76.0 85.5 95.1 110.9 179 59.3 59.376.9 76.9 86.5 96.1 112.1 180 59.9 59.977.8 77.8 87.5 97.2 113.4 181 60.6 60.678.6 78.6 88.5 98.3 114.7 182 61.3 61.379.5 79.5 89.4 99.4 115.9 183 62.0 62.080.4 80.4 90.4 100.5 117.2 184 62.6 62.681.3 81.3 91.4 101.6 118.5 185 63.3 63.382.1 82.1 92.4 102.7 119.8 41

BMI 10% Dietary Approach to Stop Hypertension trial, DASH trial 1997 2 6 DASH6-3 DASH 6-4 42

6-3 DASH *DASH DASH 1. / 1.6 5.2 2.0 4.4 8.2 7.5 0.1 2.0 0.4 0.7 0 0.7 1.5 0.5 0.8 0.6 0.2 0.5 5.8 2.5 4.1 0.7 2. 37 27 16 6 13 13 8 8 48 55 15 18 / 300 150 / 19 31 / 1700 4700 / 165 500 / 450 1240 / 3000 3000 *2100 43

6-4 DASH 7-8 1 4-5 1 6 oz 4-5 6 oz 1 1/4 2-3 8 oz 1 1% 1.5 oz 2 3 oz 1-2 1.5 oz 1/32 DASH 44

10 mmhg 6-5 6-66-76-8 6-5 100 100 ()() ()() 111 2.8 256 6.6 135 3.5 270 6.9 142 3.6 274 7.0 151 3.9 279 7.2 154 3.9 293 7.5 166 4.2 322 8.2 196 5.0 326 8.4 203 5.2 349 8.9 221 5.7 350 9.0 221 5.7 398 10.2 222 5.7 416 10.7 228 5.8 420 10.8 234 6.0 461 11.8 235 6.0 469 12.0 238 6.0 546 14.0 245 6.3 () 1482 38.0 A 254 6.5 193 4.9 65 1.5 207 5.3 () 102 2.6 214 5.5 111 2.8 221 5.7 () 112 2.9 245 6.3 125 3.2 291 7.5 130 3.3 315 8.1 135 3.5 323 8.3 167 4.3 401 10.3 170 4.4 495 12.7 176 4.5 536 13.7 181 4.6 45

6-6 (/100) 50100 101200 () 201300 301400 400 () 6-7 () 599 250 445 238 () 444 231 434 230 418 219 379 189 46

318 177 294 169 283 () 163 281 162 280 153 250 6-8 /100 100.0 32.5 45.4 17.6 100.0 39.6 44.3 11.8 100.0 48.2 42.3 4.2 100.0 86.0 6.0 2.0 100.0 47.9 38.4 9.3 100.0 17.0 47.0 31.0 100.0 15.2 40.0 40.5 100.0 15.0 23.1 57.6 100.0 12.7 24.7 58.2 100.0 10.2 20.9 63.8 100.0 9.4 12.5 73.8 80.0 49.3 23.1 3.0 47

11 mmhg JNC 72.46 6-9 48

6-106-116-1 6-9 ()/ 100 (100) 100 6-10 1. 49

2. 3. 1. 2. 3. 1. 2. 3. 50

1. 2. 6-11 1 2 2000 5 1 1 1/56 1/5 13 15 2 1/212 210 2/52 51

6-1 220/6080% 10 mmhg JNC 730 52

210 0.6 g/kg 30 cc 30 cc720 cc300 cc200 cc 60 cc60 cc 30 cc6-12 6-12 30 cccc. 30 cc(cc.) 16.50% 180 15% 200 15% 200 10.50% 290 34% 90 28.50% 100 35% 90 54% 60 19.50% 150 4.50% 670 53

withdrawal syndrome 1.6 54

55

JNC 7 140/90 mmhg 140/90 mmhg 130/80 mmhg 7-1 56

7-1 (<140/90 mmhg <130/80mmHg ( 140-159 mmhg 90-99 mmhg) thiazide ACEI, ARB, -blockers, CCB ( 160 mmhg thiazide ACEI ARBblockers, CCB (ACEI, ARB, diuretics, - blockers, CCB 140-159 mmhg 90~99 mmhg 57

160 mmhg100 mmhg angiotensin converting enzyme inhibitor, ACEIangiotensin receptor blocker, ARB -blockercalcium channel blocker, CCBthiazide 7-17-2 7-3 7-1 Class- Drug (Trade Name)-() Usual Dose Range Daily mg/d- Frequency- Thiazide diuretics Chlorothiazide (Diuril) 125-500 1 Chlorthalidone (generic) 12.5-25 1 Hydrochlorothiazide(Microzide, 12.5-50 1 HydroDIURIL)+ Polythiazide(Renese) 2-4 1 Indapamide(Lozol, Natrilix)+ 1.25-2.5 1 Metolazone(Mykrox) 0.5-1.0 1 Metolazone(Zaroxolyn) 2.5-5 1 Loop diuretics Bumetanide(Bumex, Burinex)+ 0.5-2 2 Furosemide(Lasix)+ 20-80 2 Torsemide(Demadex)+ 2.5-10 1 58

Potassium- Amiloride(Midamor)+ 5-10 1-2 sparing diuretics Triamterene(Dyrenium) 50-100 1-2 Aldosterone- Eplerenone(Inspra) 50-100 1-2 receptor blockers Spironolactone(Aldactone)+ 25-50 1-2 -Blockers Atenolol(Tenormin)+ 25-100 1 Betaxolol(Kerlone)+ 5-20 1 Bisoprolol(Zebeta)+ 2.5-10 1 Metoprolol(Lopressor, Betaloc)+ 50-100 1-2 Metoprolol extended release 50-100 1 (Toprol XL) Nadolol(Corgard)+ 40-120 1 Propranolol(inderal)+ 40-160 2 Propranolol long-acting(inderalla)+ 60-180 1 Timolol(Blocadren)+ 20-40 2 -Blockers with Acebutolol(Sectral)+ 200-800 2 intrinsic sympathomimetic activity Penbutolol(Levatol) 10-40 1 Pindolol(generic) 10-40 2 Combined Carvedilol(Coreg, Dilatrend) 12.5-50 2 -and-blockers Labetalol(Normodyne, Trandate)+ 200-800 2 59

ACE inhibitors Benazepril(Lotensin)+ 10-40 1-2 Captopril(Capoten)+ 25-100 2 Enalapril(Vasotec, Renitec)+ 2.5-40 1-2 Fosinopril(Monopril) 10-40 1 Lisinopril(Prinivil, Zestril)+ 10-40 1 Moexipril(Univasc) 7.5-30 1 Perindopril(Aceon) 4-8 1-2 Quinapril(Accupril) 10-40 1 Ramipril(Altace, Tritace) 2.5-20 1 Trandolapril(Mavik) 1-4 1 Angiotensin P Candesartan(Atacand Blopress) 8-32 1 receptor blocker Eprosartan(Tevetan) 400-800 1-2 Irbesartan(Aprovel) 150-300 1 Losartan(Cozaar) 25-100 1-2 Olmesartan(Benicar) 20-40 1 Telmisartan(Micardis) 20-80 1 Valsartan(Diovan) 80-320 1 Calcium channel Diltiazem extened release( 180-420 1 blockers- non- dihydropyridines Cardizem CD, Dilacor XR, Tiazact)+ Diltiazem extended release( 120-540 1 Cardizem LA) Verapamil immediate release( 80-320 2 Calan, Isoptin)+ Verapamil long-acting(calan 120-360 1-2 SR, Isoptin SR)+ Verapamil-coer(Covera HS, 120-360 1 Verelan PM) 60

Calcium channel Amlodipine(Norvasc) 2.5-10 1 blockers- Felodipine(Plendil) 2.5-20 1 dihydropyridines Isradipine(Dynacirc CR) 2.5-10 2 Nicardipine sustained release 60-120 2 (Cardene SR) Nifedipine long-acting (Adalat 30-60 1 CC, Procardia XL) Nisoldipine(Sular) 10-40 1 -Blockers Doxazosin(Cardura, Doxaben) 1-16 1 Prazosin(Minipress) 2-20 2-3 Terazosin(Hytrin) 1-20 1-2 Central 2 - Clonidine(Catapres) 0.1-0.8 2 agonists and Clonidine patch(catapres TTS) 0.1-0.3 1 weekly other centrally acting drugs Methyldopa(Aldomet) 250-1000 2 Reserpine(generic) 0.05-0.25 1 # Guanfacine(generic) 0.5-2 1 Direct Hydralazine(Apresoline) + 25-100 2 vasodilators Minoxidil(Loniten) + 2.5-80 1-2 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

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

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

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

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

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

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

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

thiazide thiazideacei ARB-blockerCCB () 7-4 7-4 ACE 69

() 20/10 mmhg 7-5 7-5 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

/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 6.2510/6.25) 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

() (serum potassiumk) (creatininecr) Aspirin 7-6 72

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

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

ACE 23 75

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

100 mmhg methyldopa hydralazine-- hydralazine furosemide nifedipineclonidine 77

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

ACE loop ACE hydralazineminoxidil 79

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

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

( ) 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) 8-1 2 =( ) 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% 3. 1.2.3.454.5.55 6. 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

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 ( 2.53.0 mg/dl)loop 83

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

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

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

87 () (120-139 mmhg80-89 mmhg) JNC 7 5 mmhg 14%9%7% (1) (2) (3)() (4)

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

(2) () () () 89

90

1. American Diabetes Association. Treatment of hypertension in adults with diabetes. Diabetes Care. 2003;26(suppl 1):S80-S82. 2. Black HR, Elliott WJ, Grandits G, et al. Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. JAMA. 2003;289:2073-2082. 3. 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;256:1955-1964. 4. 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;345:861-869. 5. 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;155:431-437. 6. 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;42:1206-1252. 7. Chobanian AV, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, 91

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