-

1
52
.
.
..
..168/99mmHg 78/min.
?
?
?

..




-..

 ..
.
,
.
3-5
1-2

30.
.. ,
..

1 :168/99()
2 :165/98 ()
3 :165/99 (A)
..
.
.. 2

.

.. :165/99mmHg.


ESH/ESC201

1
2
3

(mmHg)

<120
120-129
130-139
140-159
160-179
180
140

/
/
/
/
/
/

<80
80-84
85-89
90-99
100-109
110
<90

24 -

, ,
, /

,
stress

24 : ,
. , ,
- 24
:

, ,
,

24 ..

( 1
,..
/
)
(
..
,..

/ )
ESH/ESC 2013

..

..

..

140

>=90

>=125

>=85

>=120

>=70

24

>=130

>=80

>=135

>=85

HOLTER ..

( )

, , ,
( )
/ : ,
, , , , ,
, , ,
)
, , ,
()
()
-,-

: , , ,
, ...,
,
: , , ,
,(),

: , , ,

: ,
...,

( )

HDL



,

- dipstick

 :
(,, )

Triplex

HbA1c
olter
24
( )

: >55 , >65

T-CHOL>190 , LDL>115 , HDL<40/46,TRI>150

IFG,IGT
BMI >30, >102/88cm
ENEIA IA
(<55,<65)

..>=60mmHg
HK : ...
TRIPLEX:LMVindex
>3.5mV,>1.1mV

(>0.9mm)-

>0.9
...(eGFR:30-60)

(20 )
:
-
: 2 ,
..
...

BMI:29


:90,:32,/:0.8,:4.1,
:139,:5.7,eGFR:90
CHOL:240,TG:98,HDL:46,LDL:151,Ht:43%,
:..
...: S .,
R .,SV2+RV5=38mmm
TRIPLEX :...-

.. 1

O:

(BMI: 18,5-24,9 kg/m2)

5-20mmHg / 10kg

DASH

8-14mmHg

5-6
gr/

2-8mmHg

(.. )
30 ,

4-9mmHg

: 2 * .
: 1 (*1 = 15 ml )

2-4mmHg

<140mmHg()
<90mmHg(IA)
<85mmHg ..(IA)
(65-80):140-150
(>80)140-150mmHg
,

ESH/ESC2013

(,,
)
- (,
,)


A
ESH/ESC2013

JNC 8
1
(,,
)
/ARB
CCB

, ,.

:5mgr+5mgr
:
10mgr( LDL 39%)
O ,

ACCOMPLISH

Cumulative event rate

ACEI / HCTZ

20% Risk Reduction

650

ACEI / CCB
526

p = 0 .0 0 0 2

Time to 1st CV morbidity/mortality (days)

HR (95% CI): 0.80 (0.72, 0.90)

Jamerson K, et al N Engl J Med 2009

 ..

135/85 mmHg
130/80 mmHg

125/78 mmHg

130/79mmHg

128/80mmHg

132/75mmHg

130/75mmHg

:
128mmHg

:78 mmHg.

2
66 ..2,( )
850mgr, 100 mgr

.
:/ 4 88gr,
40mgr
Ca 10
2
( 100mgr)

:70kgr,BMI:29
:..
S1S2 ,
:..
..:(A):160/98mmHg
():155/95mmHg

 .. ..

,(
)
UKPDS-HDS: 10 mmHg=
..
12%

2
:
Hb1ac:6.6,TSH:2.8,:31,:1,1
eGFR:52
24:220mgr/24
LDL:98,TG:155 ,HDL:41
:
/.

X:JNC7,ADA2012(130/80mmHg
:( 2013)
: < 140mmHg
: < 80 mmHg
ESH/ESC2013
<140,<85(80)mmHg
JNC 8:<140/90 mmHg



.
: aMEA 1
: 1

,1

CCB: .
: (GFR>30).
E GFR<30, ,2 .
2013

2
aAT1(020mgr)
(cr,K)
cr>35% >5,
,

.

2o K

:..140/90 mmHg.
Cr:1,3 K:4,2 ,
24:330mgr/24
ARB?
?(
?)
2 ?

2
20 mgr/ 5mgr
..:130/80mmHg
24:290mgr/24
Cr:1.2,K:4,1


!!