서론 대상환자및방법 결과 임상적양상 Table 1. Classification of hypertension in studied patients Classification Number Mild /9099 mmhg 6 Moderate / m

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1 Origlnal Articles Korean Circulation J 1998;288: 고혈압환자에서 Losartan(Cozaar ) 의임상적효과 김남호 1 정명호 1,3 박우석 1 김성희 1 김준우 1 조장현 1 안영근 1 김남호 2,3 박주형 1 조정관 1,3 박종춘 1,3 강정채 1,3 The Clinical Effects of LosartanCozaar on Hypertensive Patients Nam Ho Kim, MD 1, Myung Ho Jeong, MD 1,3, Woo Suck Park, MD 1, Seong Hee Kim, MD 1, Joon Woo Kim, MD 1, Jang Hyun Cho, MD 1, Young Keun Ahn, MD 1, Nam Ho Kim, MD 2,3, Joo Hyung Park, MD 1, Jeong Gwan Cho, MD 1,3, Jong Chun Park, MD 1,3 and Jung Chaee Kang, MD 1,3 1 Division of Cardiology and 2 Nephrology, Department of Internal Medicine, Chonnam University Hospital, 3 The Research Institute of Medical Sciences, Chonnam National University, Kwangju, Korea ABSTRACT BackgroundLosartan potassium, one of an orally active, selective type 1 angiotensin receptor blocker, has been introduced recently as an antihypertensive agent. MethodLosartan, angiotensin receptor blocker, was administrated as an initial antihypertensive agent over 12 weeks in 30 patients 11 male, 19 female, years with stage 1 to 3 hypertension in order to observe the clinical effects. Changes in quality of life, side effects, electrocardiogram and left ventricular function were also evaluated before and after losartan therapy. Results1 After 12 weeks treatment with 50 to 100 mg of losartan, blood pressure was lowered markedly in 18 60%, moderately in 9 30% and mildly in 1 3% out of 30 patients studied. The average of blood pressures of the 30 subjects were systolic mmhg and diastolic mmhg before treatment, which were lowered to and mmhg respectively after 12 weeks p Heart rates were not changed with losartan. 3 Quality of life including general well-being, physical symptom, sleep and sexual dysfunction improved markedly in 2 7% and slightly in 17 57% out of 30 subjects. 4 Laboratory findings revealed no significant changes. 5 In electrocardiographic and echocardiographic follow-up 1 patient with ST-T abnormality and 2 patients with mild LV systolic dysfunction improved to normal. 6 Undesirable side effects were observed in 2 cases with dizziness, 1 dry cough, 1 skin rash, 1 leg edema and 1 epigastric discomfort, among whom one with dizziness stopped losartan. 7 In the final clinical assessment according to the scores of hypotensive effect, quality of life, LV function and side effect, losartan was very useful in 3 10%, useful in 18 60% and slightly useful in 3 10% out of 30 hypertensive patients. ConclusionLosartan can be used as an effective initial agent for the treatment of hypertension of various severities with the improvement of quality of life and low side effects. Korean Circulation J 1998;288: KEY WORDSHypertension Losartan Angiotensin receptor blocker. 1299

2 서론 대상환자및방법 결과 임상적양상 Table 1. Classification of hypertension in studied patients Classification Number Mild /9099 mmhg 6 Moderate / mmhg 16 Severe 180/110 mmhg Korean Circulation J 1998;288:

3 Table 2. Age and sex distribution Age Male Female Total Total 혈압변화 Table 3. Clinical characteristics and losartan dosage Case No. Age/Sex B.P. Dosage EKG Creatinine LVEF TC/HDL-C 1 60/M 170/ WNL / /M 170/ LVHST / /F 160/ LVH / /F 160/100 WNL / /F 160/ ST / /F 150/ LVHST / /M 150/ LVHST / /F 150/90 50 WNL / /M 160/ ST / /F 170/ ST / /M 160/90 50 LVH /F 170/ WNL / /M 150/ LVHST / /F 150/90 50 WNL / /M 170/ WNL / /F 180/ LVHST / /F 140/90 50 LVH / /M 160/ ST / /M 150/ WNL / /M 140/90 50 LVH / /F 140/90 50 ST / /F 140/ WN L / /F 160/ LVH / /F 170/ WNL / /F 160/ ST / /F 150/90 50 LVH / /F 170/ LVHST / /F 200/ LVHST / /F 150/ ST / /M 160/ WNL /49 LVEFleft ventricual ejection fraction, TCtotal cholesterol, HDL-Chigh density lipoprotein-cholesterol, WNLwithin normal limit, LVHleft ventricular hypertrophy, STST-T segment abnormality 1301

4 심박동수의변화 Table 4. Hypotensive effects on the severity of hypertension Hypertension Mild Moderate Severe Total % Changes Marked fall Moderate fall Mild fall No change Total 생활의질에관한변화 검사실소견의변화 심전도및좌심실기능의변화 Fig. 1. Changes of systolic and diastolic blood pressure before and after losartan administration *p Korean Circulation J 1998;288:

5 Table 5. Blood pressure and heart rate changes before and after losartan administration Case Blood pressure mmhg Heart rate /min No. Before After Before After 1 170/ / / / / / /100 stop 92 stop 5 160/ / / / / / /90 110/ / / / / /90 130/ / / / / /90 110/ / / / / /90 130/ / / /90 120/ /90 130/ /90 140/ / / / / / / / / /90 130/ / / / / / / / / Mean / SD / Table 6. Changes in quality of life Case No General Physical well-being symptom Sleep and sexual dysfunction Total score improved, 0no change, worsened, 3 markedly improved, 12slightly improved, 0 no change, 13aggravated 부작용 종합적임상유용성판정 고찰 1303

6 Table 7. Side effects after losartan Side effects Case No. Percentage (%) Persistent cough 1 3 Skin rash 1 3 Dizziness 2 6 Leg edema 1 3 Epigastric discomfort 1 3 Total 6 20 Table 8. Final assessment of losartan effects Case No. Hypotensive effect Quality of life Side effect Improvement of LV function Total score Conclusion 1 4 very useful 2 2 useful 3 0 useless useless 5 3 useful 6 2 useful 7 2 useful 8 1 slightly useful 9 3 useful 10 0 useless 11 0 useless 12 very useful 13 3 useful 14 0 useless 15 2 useful 16 1 slightly useful 17 2 useful 18 2 useful 19 3 useful 20 2 useful useful 22 4 very useful 23 2 useful 24 3 useful useful 26 2 useful 27 0 useless useful 29 2 useful slightly useful 45very useful, 23useful, 1slightly useful, 0useless 1304 Korean Circulation J 1998;288:

7 요약 연구배경 : 방법 : 1305

8 결과 : 1306 결론 : 중심단어 REFERENCES 1) Weinberger MJ. Angiotension-converting enzyme inhibitors. Med Cl North Am ) Oliverio MI, Coffman TM. Angiotensin receptors New targets for antihypertensive therapy. Clin Cardiol ) Jeong MH, Shin SC, Yang SJ, Park SJ, Kim SG, Cho JG, et al. A clinical study on the antihypertensive effects of enalapril. Korean Circulation J ) Jeong MH, Shin SC, Yang SJ, Park SJ, Kim SG, Cho JG, et al. A clinical study for the captopril effects on hypertensive patients. Korean Circulation J ) Park DG, Lee MM, Chai IH, Rhee MY, Lee HJ, Kim HS, et al. The antihypertensive efficacy, safety, and tolerability of losartan versus fosinopril in patients with hypertension. Korean Circulation J ) Joint National Committee. The sixth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure JNC. Arch Intern Med ) Anderson GH, Streeten DHP, Dalakos TG. Pressure response to 1-sar-8-ala-angiotensin saralasin in hypertensive subjects. Cir Res ) Wong PC, Price WA, Chiu AT, Duncia JV, Carini DJ, Wexler RR, et al. In vivo pharmacology of DuP 753. Am J Hypertens S-98S. 9) Duncia JV, Carini DJ, Chiu AT, Johnson AL, Price WA, Wong PC, et al. The discovery of DuP 753, a potent, orally active non-peptide angiotensin receptor antagonist. Med Res Rev ) Weber MA, Byyny RL, Pratt JH, Faison EP, Snavely DB, Goldberg AI, et al. Blood pressure effects of the antiotensin receptor blocker, losartan. Arch Intern Med ) Ito M, Oliverio MI, Mannon PJ, Best CF, Maeda N, Smithies O, et al. Regulation of blood pressure by the type A angiotension receptor gene. Proc Natl Acad Sci USA ) Goldberg AI, Dunlay MC, Sweet CS. Safety and tolerability of losartan compared with atenolol, felodipine and angiotensin converting enzyme inhibitors. J Hypertension S77-S80. 13) Goldberg AI, Dunlay MC, Sweet CS. Safety and tolerability of losartan potassium, an angiotensin receptor antagonist, compared with hydrochlorothiazide, atenolol, felodipine ER, and angiotensin-converting enzyme inhibitors for the treatment of systemic hypertension. Am J Cardiol ) Dahlof BD, Keller SE, Makris L, Goldberg AI, Sweet CS, Lim NY. Efficacy and tolearability of losartan potassium and atenolol in patients with mild to moderate essential hypertension. Am J Hypertension ) Gradman AH, Arcuri KE, Goldberg AI, Ikeda LS, Nelson EB, Snavely DB, et al. A randomized, placebocontrolled, double-blind, parallel study of various doses of losartan potassium compared with enalapril maleate in patients with essential hypertension. Hypertension ) Mallion JM, Bradstreet DC, Makris L, Goldberg AI, Halasz S, Sweet CS, et al. Antihypertensive efficacy and tolerability of once daily losartan potassium compared with captopril in patients with mild to moderate essential hypertension. J Hypertension S35-S41. 17) Oparil S, Barr E, Elkins M, Liss C, Vrecenak A, Edelman J, et al. Efficacy, tolerability, and quality of life of losartan, alone or with hydrochlorthiazide, versus amlodipine, alone or with hydrochlorothiazide, in patients with essential hypertension. Clin Ther ) Croog SH, Levine S, Testa MA, Brown B, Bulpitt CJ, Jenkins CD, et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med ) Fuller RW, Choudry NB. Increased cough reflex associated with angiotensin converting enzyme inhibitor. Br Med J ) Morice AH, Lowry R, Brouwn MJ, Higinbotam T. Angiotensin converting enzyme and the cough reflex. Lancet Korean Circulation J 1998;288:

서론 938 대상및방법 대상 방법 Korean Circulation J 1999;299:

서론 938 대상및방법 대상 방법 Korean Circulation J 1999;299: Original Articles Korean Circulation J 1999;299:937-943 경증및중등도본태성고혈압환자에서 Candesartan CilexetilAtacand 의강압효과및 임상적안전성에대한연구 강석민 1 정남식 1 최동훈 1 안신기 1 임세중 1 하종원 1 장양수 1 심원흠 1 조승연 1 김성순 1 이선호 2 A Clinical Study