(Guidelines in the treatment of hypertension)

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.

1. SBP DBP ( 1-3)

2. 55
3. 65
4.
5. total cholesterol >240 ./. LDL-cholesterol >160 ./.
6. HDL-cholesterol <40 ./. <45 ./.
7. ,
( 55 65 )
8. ( Body mass index > 25 ./..)

(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)

(Body mass index)

= 18.5-24.9 ./..
DASH diet (DASH-Dietary
Approach to Stop Hypertension)

100 mmol (2.4

6
)

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

Elderly with ISH

Renal disease
Diabetic nephropathy type 1
Diabetic nephropathy type 2
Non-diabetic nephropathy
Cardiac disease
Post-MI

Diuretic
Dihydropyridine CCB

Stroke
Stroke

ACEI
ARB
ACEI

Progression of renal failure

Progression of renal failure
Progression of renal failure

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

High degree heart block

Severe bradycardia <50/min
Obstructive airways disease
Raynauds

Clonidine
Methyldopa
Reserpine

Withdrawal syndrome
Hepatotoxicity
Depression
Active peptic ulcer

Diuretic

Gout

CCBs

congestive heart failure

isolated office hypertension

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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