확장기혈압의증가와혈관질환의증가 2. 수축기혈압의증가와혈관질환발생과의관계 P i P s P d t p t r Flow Pressure Fig. 1. Amplitude and timing of wave reflection. Kor J Cerebrovascula

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1 KISEP KOR J CEREBROVASCULAR SURGERY September 2004 Vol. 6, No 2, page 고혈압과혈관질환 고혈압의약물치료 연세대학교의과대학영동세브란스내과학교실, 순환기내과 김동수 Hypertension and Vascular Disease Pharmacologic Management of Hypertension Dongsoo Kim, MD Cardiology Division, Yonsei University College of Medicine, Seoul, Korea ABSTRACT Hypertension is one of the common diseases nowadays. In the aspects of management, the precise prevention of its complications is more important than normalization of blood pressure level itself. Systemic considerations for medical treatment such as side effects, efficacy, compliance for medicine, long-term evaluation of complications should be the essential points of medical treatment for hypertension. (Kor J Cerebrovascular Surgery 6:114-21, 2004) KEY WORDS:Hypertension Medical treatment Complications. 서, 서울강남구도곡동 연세대학교의과대학영동세브란스내과학교실, 순환기내과 전화 :(02) , 2330 전송 :(02) kim0426@yumc.yonsei.ac.kr 론 114

2 확장기혈압의증가와혈관질환의증가 2. 수축기혈압의증가와혈관질환발생과의관계 P i P s P d t p t r Flow Pressure Fig. 1. Amplitude and timing of wave reflection. Kor J Cerebrovascular Surgery 6:114-21,

3 3. 고혈압치료의최근연구 Males Mazard ratios And 95% CI Likelihood Ratio 2 Females Mazard ratios And 95% CI Likelihood Ratio 2 50 years SBP DBP PP NAP years SBP DBP PP NAP years SBP DBP PP NAP years SBP DBP PP NAP Hazard ratios Hazard ratios Fig. 2. 성별및연령에따른혈압인자와허혈성심진환발생의위험도. 수축기혈압 { 평균 표준편차, mmhg 클로를탈리돈군암로디핀군리시노프릴군 암로디핀구 vs 클로르탈리돈군 리시노프릴군 vs 클로르탈리돈군 베이스라인 년후 년후 확장기혈압 { 평균표준편차, mmhg 베이스라인 년후 년후 Fig. 3. ALLHAT Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial study. 116 Kor J Cerebrovascular Surgery 6:114-21, 2004

4 1) 혈관확장제편중바꿔야 2) 강압목표치지금의가이드라인으로충분한가? 3) 고령자에서의강압제선택, 강압목표방향 Table 1. 고령자고혈압의치료차트 Ca ACE-I/ARB 2 23 ACE-I/ARB Ca Ca ACE-I/ARB 3 CaACE-I/ARB 140 mmhg 090 mmhg 150 mmhg 090 mmhg 160 mmhg 090 mmhg ACE-IARB-AII 2002 Kor J Cerebrovascular Surgery 6:114-21,

5 4. 고혈압약물치료의원칙 1) 강압제의적응과금기 2) 각종강압제의특성 Kor J Cerebrovascular Surgery 6:114-21, 2004

6 3) 병용약제의조합 4) 강압제처방의실제 약제종류 적극적적응 적용가믄 금기가능 절대금기 이뇨제 심부전노인 당뇨병 지질대사이상 통풍 성기능활발하남자 베타차단제 협심증심근경색후 심부전임신 지질대사이상운동선수및신체활동이활발한환자 천식및 CCPD 23도방실블록 빈맥성부정맥 당뇨병 말초혈관집환 ACE억제제및 AI 차단제 심부전좌시실기능장애심근경색후 임신고K혈증양측신통역협착 당뇨병신병증 칼슘길항제 혐심증 말초현관질환 올혈성심부전 23도방식블록 알파차단제 전립선비대증 내당뇨이상지질대사이상 기립성저혈압 Fig. 4. 합병증및위험인자에따른강압제선택지침WHO/ISH 1 차선택 2 차선택하위선택또는기피금기 남자 60 세 여자 60세, 심박수 > 80분심박수 70분 디히드로피리딘 Ca 길항제 이뇨제베타차단제, Verapernal Ditiazen ACE 억제제, 디히드로파리딘 ACE 억제제 디히드로피리딘 베타차다제 두통, 부종, 안면홍조, 빈맥의부작용인뇨제, 베타차단제 ACE 억제제디히드로피리딘 피로, 무력증 베타차단제 고지혈증 Ca 길항제, ACE 억제제알파차단제베타차단제 당뇨, 내당뇽저하 Ca 길항제, ACE 억제제알파차단제베타차단제 협심증 Ca 길항제, 베타차단제 심근경색과거력 베타차단제, ACE 억제제 심부전 ACE 억제제, 이뇨제 베타차단제극소량알파차단제디히드로피리딘 베타차단제상용량, Verapernal Ditiazen 부정맥, 빈맥성 23도 A-V블록 베타차다제, Verapernal Ditiazen 뇌졸증과거력 TIA Ca 길항제, ACE 억제제 베타차단제 알파사단제 베타차단제 Verapernal Ditiazen 신기능장애 특히당뇨병성신병증 Fig. 5. 위험인자별강압제선택. ACE 억제제 Kor J Cerebrovascular Surgery 6:114-21,

7 5) 고혈압성위급증 (Hypertensive crisis) - 결 중심단어 : REFERENCES 1) Braunwald E, Zipes DP, Libby P. Heart Disease. A Textbook of Cardiovascular Medicine. 6 th ed. W.B. Saunders, 2001, pp ) MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, et al. Blood pressure, stroke, and coronary heart disease: I. Prolonged 론 120 Kor J Cerebrovascular Surgery 6:114-21, 2004

8 differences in blood pressure: Prospective observational studies corrected for the regression dilution bias. Lancet 335:765-74, ) Flack J, Madhaven S, Cohen H. Isolated diastolic hypertension. Favorable findings among young and middle aged hypertensive subjects. Hypertension 26:377-82, ) Menotti A, Jacobs DR Jr, Blackburn H, Kromhout D, Nissinen A, Nedeljkovic S, et al. Twenty five year prediction of stroke deaths in the Seven Countries Study. The role of blood pressure and its change. Stroke 27:381-7, ) Nielsen WB, Lindenstrom E, Vestbo J, Jensen GB. Is diastolic hypersion and independent risk factor for stroke in the presence of normal systolic blood pressure in the middle-aged and elderly? Am J Hypertension 10:634-9, ) Collins R, McMahon S. Blood pressure, antihypertensive drug treatment and the risk of stroke and of coronary heart disease. Br Med Bull 50:272-98, ) Kannel WB, Dawber TR, Mc Gee DL. Perspective on systolic hypertension. The Framingham Study. Circulation 61: , ) Lawes CM, Bennett DA, Parag V, Woodward M, Whitlock G, Lam TH, et al. Blood Pressure Indices and Cardiovascular Disease in the Asia Pacific Region: A Pooled AnalysisAsia Pacific Cohort Studies Collaboration Hypertension 42:69-75, ) Jackson CD, Wright Jr, Davis WR, Cutler JA. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The antihypertensive and lipid-lowering treatment to prevent heart attack trial(allhat) JAMA 288: , ) PROGRESS Collaborative Group Randomized trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischemic attack, Lancet 358: , ) Guidelines for antihypertensive treatment: an update after the ALLHAT study. J Am Soc Nephrol 15 Suppl 1:51-4, ) Prisant LM, Moser M. Hypertension in the Elderly: Can We Improve Results of Therapy? Arch Intern Med 160:283-9, ) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA May 21;289: May 14. Erratum in: JAMA Jul 9;290:197 Kor J Cerebrovascular Surgery 6:114-21,

Treatment and Role of Hormaonal Replaement Therapy

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