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Hypertension () 140/90 .
Isolated systolic hypertension 140 .
90 .
Isolated office hypertension
140/90 .
135/85 . ()
1 (. ) 18
Category
SBP
DBP
optimal
<120
<80
normal
120-129
80-84
high normal
130-139
85-89
grade 1 hypertension (mild)
140-159
/
90-99
grade 2 hypertension (moderate)
160-179
/
100-109
grade 3 hypertension (severe)
>180
/
>110
Isolated systolic hypertension
>140
<90
SBP systolic blood pressure; DBP diastolic blood pressure; SBP
DBP
1.
-blocker,
2.
polycystic kidney disease pheochromocytoma
3. ()
4. ,
5.
pheochromocytoma
primary aldosteronism 2 renal
stone pyelonephritis
1.
( 1)
3 1-2
2. (left ventricular
hypertrophy-LVH) (chronic kidney disease-CKD)
(stroke)
(atherosclerosis) (retinopathy)
(hemorrhage) (exudates)
(papilledema)
3.
2 (polycystic kidney disease)
2
(Takayasus disease) 2
(coarctation of aorta) 2 (renal artery
stenosis) Caf au lait spot (neurofibroma)
(pheochromocytoma) (primary
aldosteronism) (hemangioma)
cerebellum (von Hippel-Lindau disease) (chronic kidney
disease)
1.
30
5 2
2.
digital
arm cuff (bladder)
80 arm cuff 12-13 .x35 .
3.
- arm cuff 2-3 .
brachial artery
- SBP (rubber bulb)
brachial artery
2-3 ./ SBP
- stethoscope brachial artery
SBP 20-30 .
(Korotkoff 1) SBP (Korotkoff 5)
- 2 1-2
+ 5 . 2 5 . 3
+ 5 .
- 2
1 SBP SBP
20 . orthostatic hypotension orthostatic
hypotension SBP SBP
(automatic blood pressure
measurement device)
1. ()
2.
3. 3
4. sphygmomanometer 5 .
135/85 .
5. isolated office hypertension
1. Fasting plasma glucose
2. Serum total cholesterol , high density lipoprotein (HDL) cholesterol, low density lipoprotein
(LDL) cholesterol, fasting serum triglyceride
12
3. Serum creatinine
4. Serum uric acid
5. Serum potassium
6. Hemoglobin hematocrit
7. Urinalysis (dipstick test urine sediment)
8. Electrocardiogram
4
1. Echocardiogram
2. Carotid ultrasound carotid bruit
3. Post prandial plasma glucose fasting plasma glucose 110-126 ./.
4. Microalbuminuria
5. proteinuria urine protein/creatinine ratio
dipstick
6. fundoscopy
2
1. total cardiovascular risk
(target organ damage)
(associated clinical condition)
2.
(Target organ
damage-TOD)
1. Left ventricular hypertrophy (LVH) echocardiogram
5
2. microalbuminuria (30-300 /)
3. ultrasound atherosclerotic plaque aorta, carotid, coronary,
iliac femoral arteries
4. (hypertensive retinopathy) 3 4
(Associated clinical condition-ACC)
1.
(coronary heart disease
equivalent)
2.
- ischemic stroke
- cerebral hemorrhage
- transient ischemic attack
3.
- myocardial infarction
- angina
- coronary revascularization
- congestive heart failure
4.
- plasma creatinine >1.3 ./., >1.2 ./.
- glomerular filtration rate (GFR) creatinine clearance (CCr) <60 ./
- albuminuria >300 ./ proteinuria >500 ./
5.
( 2)
aerobic
( 30
)
2
drinks/ (ethanol 30
/ 720 .,
300 . , 90 .)
1 drink/
SBP
5-20 .
10 .
8-14 .
2-8 .
4-9 .
2-4 .
10 ( 3)
3 10
(.)
1
2
3
(SBP 140-159 (SBP 160-179
(SBP >180
DBP 90-99)
DBP 10-109)
DBP >110
1.
2. 1-2
3. 3
TOD ACC
10 < 15 % , 15
< 20 % , > 20 %
( 1)
1
(BP >140/90 .
BP >130/80 . CKD)
BP
3-6
BP
6-12
BP >140/90 .
BP <140/90 .
BP
8
1. BP < 140/90 .
2. BP < 130/80 .
3. < 130/80 . proteinuria < 1 / < 125/75 .
proteinuria > 1 /
1.
5
- diuretic
- -blocker
- calcium channel blocker (CCB)
- angiotensin converting enzyme inhibitor (ACE-inhibitor)
- angiotensin receptor blocker (ARB)
-blocker
methyldopa, clonidine, reserpine
2.
2
low dose combination
3. > 20/10 .
2
4.
Diuretics
-blocker
Angiotensin
receptor
antagonists
-blocker
Calcium
antagonists
ACE inhibitors
5 ()
() ()
dihydropyridine CCB -blocker
5.
( 4)
10
Diuretic
Dihydropyridine CCB
Stroke
Stroke
ACEI
ARB
ACEI
ACEI
-blocker
Left ventricular dysfunction
ACEI
CHF (diuretics almost always included) ACEI
-blocker
Spironolactone
Left ventricular hypertrophy
ARB
Cerebrovascular disease
Diuretic + ACEI
Diuretic
ACEI ARB
Mortality
Mortality
Heart failure / Mortality
Mortality
Mortality
Mortality
CV morbidity and mortality
Recurrent stroke
Recurrent stroke
6.
( 5)
11
CHF
ACEIs, ARBs
Pregnancy
-blockers
Bilateral renal artery stenosis
Hyperkalemia
-blocker
Clonidine
Methyldopa
Reserpine
Withdrawal syndrome
Hepatotoxicity
Depression
Active peptic ulcer
Diuretic
Gout
CCBs
TOD
TOD
12
( 6)
6
(.)
SBP
DBP
<140
<90
140-159
90-99
160-179
100-109
180
110
1
2
1
1.
2.
3. , e-mail
4.
5.
6.
7.
8.
9.
13
10.
11.
12.
References
1. World Health Organization, International Society of Hypertension Writing Group. 2003 World
Health Organization (WHO)/International Society of Hypertension (ISH) statement on management
of hypertension. J Hypertens 2003;21:1983-1992.
2. Practice Guidelines Writing Committee. Practice Guidelines for Primary Care Physicians:2003
ESH/ESC Hypertension Guidelines. J Hypertens 2003;21:1779-1786.
3. The JNC 7 Report. The Seventh Report of the Joint National Committee on Prevention, Detection,
Evaluation and Treatment of High Blood Pressure. JAMA 2003;289:2560-2572.
4. Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood
Pressure. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation
and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413-2446.
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