:

2014

 -
. ., 68 ,
.. 174170/106-100 mmHg 10,
.

40


(+):

51

: tabs O


= 178/100 mmHg
(2
, min)
= 170/96 mmHg
= 72/min
:
174-170/106-100 mmHg (3-4 )


87 kg 1,69 m 30,5 Kg/m2
= 108 cm
: S1, S2 ,
.
: .. ..
:

: --, ..

 ;
1. 6 ;

2. ;
3.

;
4.

 :


,
,
.

 24 (BPM)

,
24-
,
.

.


.

,

.

24 (PM)

24 -

172

98

123

68

07:00-23:00

178

100

123

69

23:00-07:00

170

96

120

66


Ht: 45%

. A

WBC: 8520
PLT: 268x 103

. = 1025

= (-)
= (-)


(> 300mg/g)
,
Alb/Cr.
:
-
.
-
CVD.

lb/Cr = 49 mg/g
(.. 3,4 - 34 mg/g)
24
U/S NOK:


(
): 110 mg/dl
: 46 mg/dl
: 1,2 mg/dl
eGFR: 70 ml/min/1,73m2
: 3,1 mg/dl
: 4,4 mEq/l
: 142 mEq/l

: 268 mg/dl
LDL: 146 mg/dl
HDL: 37 mg/dl
: 214 mg/dl
HbA1c: 5,9 %
:
. : 116 mg/dl
. 2 : 175 mg/dl

Sokolov (Sv1 + Sv5 > 35mm)

R aVL > 11mm

strain I, aVL,V6

ECHO
...
LA: 39mm
LV: ,

F: 55%
AVR: ,

VR: 1+/4+ < E/A=0,9 E<8cm

TRV: 1+/4+ RSVP: 25 mmHg


:

:
1.
(IMT > 0,9)
2. - (ABI) < 0,9
3. -
(PWV > 12 m/sec)

,
Grade 2 A :
-
( ),
- :
- ,
- ,
-

.
1)
;
2)
;
3)
,
;

1. :

2. vs.

Combination treatment vs monotherapy

in reducing BP: meta-analysis on 11.000
pts from 42 trials
2

5


Wald et al, Am J Med 2009;122:290-300

 :
Reduced discontinuation of antihypertensive treatment by
two-drug combination as first step. Evidence from daily
life practice. Corrao G, Parodi A, Zambon A, Heiman F, Filippi
A, Cricelli C, Merlino L, Mancia G.

J Hypertens 2010;28:15841590.

3.

 :
abl. 10mg

abl. 5mg

ACCOMPLISH Total population

20%

n=11,516

Jamerson, NEJM 2008

ASCOT - CV events
Prevention of cardiovascular events with an antihypertensive
regimen of amlodipine adding perindopril as required vs. atenolol
adding bendroflumethiazide as required in the Anglo-Scandinavian
Cardiac Outcomes Trial - Blood Pressure Lowering Arm (ASCOTBPLA) a multicentre randomised controlled trial.
/
/ 16% (P <
0,001)

Lancet 2005; 366:895906.

 :
abl. 10mg,
abl. 5mg

, : 160 154/92-98
mmHg.

 :
abl. 20 mg,
abl. 10mg
6
.
PM

24 -

144

86

105

70

07:00-23:00

148

88

108

72

23:00-07:00

140

82

101

68

;;;;;
-
- (
)
-
-