(Treatment of Hypertension with Associated Diseases) 1.. (140/90 mmhg). 80 mmhg. ( ). (atenolol ), (amlodipine ) 1. -1 nitrate. ACE diltiazem, verapamil. ACE. ( )., ACE diltiazem,, diltiazem, verapamil. ; (Adalat capsule).. diltiazem, verapamil. ;,, (propranolol, 161
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
: ( down regulation,,, ). ISA 1 (propranolol, metoprolol, acebutolol ).. ACE 1-2 2.. :. 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.,,.. ACE,,. minoxidil hydralazine. : ACE,,,,. : minoxidil, hydralazine. 5. (, ACE, ).. Digitalis..... 6.,,. 40% 2.5. 1 130/85 mmhg 164
. 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
:, clonidine, methyldopa : ACE,,, :,, clonidine, methyldopa : ACE,, loop, minoxidil : : ACE,, : 7.. Thiazide loop :,, LDL- thiazide. Indapamide spironolactone. : ISA HDL. 2-3. ISA. :,, LDL HDL 1. ACE, A-II,, :. :,, ACE, A-II,, pindolol, acebutolol : ( ), propranolol, metoprolol, atenolol. 166
8. 1) A..., 180 mmhg 105 mmhg 160 mmhg. B. -.. Lacuna. (1 ) ACE 1 2-3 140-160/90-95 mmhg. 2 ) A. 90%.. 200/110 mmhg 20% 160-180/90-100 mmhg. ( ) mannitol. B. 1 5-10 mmhg 140-150/ 85-90 mmhg. 80 mmhg J ACE 167
1.. 2-3 140-160/90-95 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 :,. 1 1 1 g, ACE. Cr 3 mg/dl. K K. ACE 3 Cr 1 mg/dl ACE.. NSAID. 168
A-I ACE chymase A-II ACE A-II. :. 1. 1 1-2 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 1 300 ml Lasix (40-200 mg). Renin-angiotensin ACE. 10. 1) 140/90 mmhg 169
25 mmhg, 15 mmhg. 40%.. 75 mmhg 85 mmhg. 90-95 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 ) 3-4. 60% 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
. :. ACE : captopril lisinopril (5-10 mg 1 ) enalapril, cilazapril prodrug. Methyldopa:. : ( ),, : ACE, A-II,,, : Methyldopa, ( ), labetalol 13. SLE., renin. NSAID prostaglandin,,,. renin ACE. 14. 180/110 mmhg. ACE 1.... 172
15... ACE,. ACE : prostaglandin 1. : DHP. :. : Raynaud. :. : ACE,, : 16. 1).,,.. digitalis. ACE. 1. : 173
2 ). ACE.. : ACE, : 17.,,, reserpine, methylodopa propranolol metoprolol.. : ACE, A-II,,,, : methyldopa,, clonidine 18. 3... Thiazide loop :.. :. ACE : AII. 174
:, A-II, indapamide, : thiazide loop, 1.. ( ). 2000 pp13-30. 2. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413-46. 3. The Guidelines Subcommittee: 1999 World Health Organization-International Society of Hypertension. Guidelines for the Management Hypertension. J Hypertens 1999;17:151-183. 4. The Guidelines for Management of Hypertension: report of the third working party of the British Hypertension Society. J Human Hypertens 1999;13:569-592. 5. Kaplan NM. Clinical Hypertension. 7th ed. p.181-263, Baltimore, Williams & Wilkins. 6., 2000. 7. 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;313:147. 8. 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; 317:713-720. 175