심장2.PDF

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1 (Treatment of Hypertension with Associated Diseases) 1.. (140/90 mmhg). 80 mmhg. ( ). (atenolol ), (amlodipine ) nitrate. ACE diltiazem, verapamil. ACE. ( )., ACE diltiazem,, diltiazem, verapamil. ; (Adalat capsule).. diltiazem, verapamil. ;,, (propranolol, 161

2 metoprolol ). ISA (intrinsic sympathomimetic activity) (pindolol, acebutolol),. Q verapamil diltiazem. :. : hydralazine. : ( ),, ACE : ( ), (ISA ) 2. 75%. ACE... renin-angiotensin. ACE angiotensin. ACE :... ACE hydralazine isosorbide dinitrate (ISDN) carvedilol ACE. Angiotensine II (A-II) captopril. ACE. 1-2, 3, 6. :,, ACE.. Spironolactone. 162

3 : ( down regulation,,, ). ISA 1 (propranolol, metoprolol, acebutolol ).. ACE :. amlodipine felodipine ACE, digoxin. Diltiazem, verapamil, nifedipine... :, ACE A-II, dihydropyridine (DHP) : ( ), diltiazem, verapamil 3. K Mg thiazide furosemide. ACE K K. ISA atenolol, bisoprolol DHP..,,,,,. digoxin digoxin. 163

4 4.,,.. ACE,,. minoxidil hydralazine. : ACE,,,,. : minoxidil, hydralazine. 5. (, ACE, ).. Digitalis ,,. 40% /85 mmhg 164

5 . ACE. ACE,,, 1. ACE :, K. :. K+. :.,.. :. : ACE. :, atenolol, metoprolol, celiprolol, ACE, A-II. : hydralazine, minoxidil, DHP (nifedipine) : ACE,, (amlodipine, felodipne) :, (verapamil. diltiazem) : ACE, : :, ACE 165

6 :, clonidine, methyldopa : ACE,,, :,, clonidine, methyldopa : ACE,, loop, minoxidil : : ACE,, : 7.. Thiazide loop :,, LDL- thiazide. Indapamide spironolactone. : ISA HDL ISA. :,, LDL HDL 1. ACE, A-II,, :. :,, ACE, A-II,, pindolol, acebutolol : ( ), propranolol, metoprolol, atenolol. 166

7 8. 1) A..., 180 mmhg 105 mmhg 160 mmhg. B. -.. Lacuna. (1 ) ACE /90-95 mmhg. 2 ) A. 90%.. 200/110 mmhg 20% / mmhg. ( ) mannitol. B mmhg / mmhg. 80 mmhg J ACE 167

8 /90-95 mmhg. : ACE, A-II,,,, :, methyldopa 9..,. Cr 2.0 mg/dl Ccr 60 ml/ Cr 2.0 mg. 1 1g 130/80 mmhg 1 gm 125/75 mmhg. Thiazide : creatinine 2.0 mg/dl Ccr 25 ml/. furosemide loop. ACE A-II :, g, ACE. Cr 3 mg/dl. K K. ACE 3 Cr 1 mg/dl ACE.. NSAID. 168

9 A-I ACE chymase A-II ACE A-II. : DHP (Adalat SR, Perdipine LA, Novasc ). : minoxidil. : GFR RBF Cr 2.0 mg/dl -1 (Inderal, metoprolol, Trandate ).. : GFR. : ACE, A-II,,,,. :, (spironolactone, amiloride) Na ml Lasix ( mg). Renin-angiotensin ACE ) 140/90 mmhg 169

10 25 mmhg, 15 mmhg. 40%.. 75 mmhg 85 mmhg mmhg 100 mmhg. 170/110 mmhg. Methyldopa 1. Hydralazine,,,. atenolol metoprolol. Mg sulfate. Thiazide,. ACE A II (fetal hypotensive syndrome). hydralazine, nifedipine, labetalol methyldopa, prazocin, nifedipine, hydralazine. : hydralazine, methyldopa, labetalol,,, : ACE, A-II 2 ) % 35%. 5-7 mmhg 2-5 mmhg...,,. A-II osteoclast ACE 170

11 :. -l labetolol. : 1.. COPD theophylline -2 nifedipine verapamil diltiazem. : 1. :. ACE : (20-30%). Angiotensin-II. sympathomimetic agent. :,, ACE, A-II,, : ( ) 12. : thiazide 90% furosemide. Spironolactone (Aldacton). : (atenolol ) (propranolol, metoprolol ) (doxazocin) - (labatalol) 171

12 . :. ACE : captopril lisinopril (5-10 mg 1 ) enalapril, cilazapril prodrug. Methyldopa:. : ( ),, : ACE, A-II,,, : Methyldopa, ( ), labetalol 13. SLE., renin. NSAID prostaglandin,,,. renin ACE /110 mmhg. ACE

13 15... ACE,. ACE : prostaglandin 1. : DHP. :. : Raynaud. :. : ACE,, : 16. 1).,,.. digitalis. ACE. 1. : 173

14 2 ). ACE.. : ACE, : 17.,,, reserpine, methylodopa propranolol metoprolol.. : ACE, A-II,,,, : methyldopa,, clonidine Thiazide loop :.. :. ACE : AII. 174

15 :, A-II, indapamide, : thiazide loop, 1.. ( ) pp The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1997;157: The Guidelines Subcommittee: 1999 World Health Organization-International Society of Hypertension. Guidelines for the Management Hypertension. J Hypertens 1999;17: The Guidelines for Management of Hypertension: report of the third working party of the British Hypertension Society. J Human Hypertens 1999;13: Kaplan NM. Clinical Hypertension. 7th ed. p , Baltimore, Williams & Wilkins. 6., Rodgers A, MacMahon S, Gamble G, Slattery J, Sandercock P, Waflow C: for the United Kingdom Transient Ischaemic Attack Collaborative Group: Blood pressure and risk of stroke in patients with cerebrovascular disease. Br Med J 1996;313: Feldman RD, on behalf of the Task force for the Development of the 1999 Canadian Recommendations for the Management of Hypertension. The 1999 Canadian recommendations for the management of hypertension. Can J Cardiol. 1999; 15(suppl G):S57G-S64G. 9. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ. 1998; 317:

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<3034C0D3BBF3C3E1B0E8C7D0BCFABCBCB9CCB3AA2E687770> 2004년 대한임상건강증진학회 춘계학술대회 Korean Society for Health Promotion and Disease Prevention [세미나 Ⅱ] 병 의원에서 건강 증진의 활성화 선우 성 울산의대 서울아산병원 가정의학과 우리 개원가의 현실은 구조적으로 일차진료의의 중요한 기 능 중의 하나인 건강증진 상담을 제대로 할 수 없도록 짜여 져 있다.