( :160/100mmHg)

2




, .

 52 BMI:35 WC:98 cm.

.
: Glu:113mg/dl,
Chol:171mg/dl, TGL:130 mg/dl, HDL:55mg/dl,
LDL:90 mg/dl, SGOT:40IU/L, SGPT:45IU/L ,
U:38 mg/dl, Creat:0.9 mg/dl.
OGTT: Glu(0m): 113mg/dl, Glu(60m):180 mg/dl,
Glu(120m): 240mg/dl.
K : : 170/100mmHg, 70bpm.


IDF 2005

Waist >94 cm
>80 cm
+ 2 :
150 mg/dL
HDL < 40 mg/dl
HDL <50 mg/dl
. 130/85mmHg x
100 mg/dL
Alberti KG, Zimmet P, Shaw J. The metabolic syndrome: a new worldwide definition. Lancet 2005;366:1059-1062


Tab 5 mg qd.

T ;

2
.

.

.
HbA1c


FPG

128

135

132

130

139

129

PPG

235

206

220

250

198

259

 H HbA1c= 7,2%

160/100 mmHg.

>
10
1C

1C

< 6,0

< 6,5

< 6,5

< 9,0%

+
6,5 7,0

< 7,0

+
7,0 8,0

>9,0

Diabetes Metab Res Rev 2010;26:239


2
A 2011
A1c > 8.5%
( )

A1C < 8.5%

+ 1

A1C > 9%
()

+
TZD
MET +
GLP-1 DPP-4
SU GLIN

2-3
>7%

+
TZD
MET +
GLP-1 DPP-4
SU GLIN

+ +/-

2-3
>7%

A1c<8%

A1c<8%
A1c>8%

+
TZD + SU
MET +
GLP-1 DPP-4 2 + SU
GLP-1 DPP-4 + TZD

1.

2.

3.

DPP-4 ()

2-3
>7%

+ +

A1c>8%

2-3
>7%


.
Tab 850 mg bid

Gastrointestinal side effects

HbA1c

(%)

HbA1c (%)

0
-0.5

-1
-1.5
-2
-2.5

10
8
6
4
2
0

500

1000

1500

2000

2500

(mg)

500

1000

1500

2000

2500

(mg)

Garber AJ, et al. Am J Med 1997; 103:491497.


( 5-6 gr/ )
( 10-20gr/
20-30 gr/ )
( B 5 Kg
4,4 mmHg 3,6mmHg )
( 30 min
3 mmHg 2,4 mmHg
6,9 mmHg 4,9 mmHg
)


2 ,
.

uan Hueim et al,Hypertension. Pathogenesis, risc factors and

prevention. 2010.

Aged under
55 years

Aged over 55 years

or black person of
African or Caribbean
family origin of any
age
C2

A+

C2

Step 1

Step 2

A+C+D

Step 3

Resistant hypertension

Step 4

Summary of
antihypertensiv
e
drug treatment
Key
A ACE inhibitor or low-cost
angiotensin II receptor
blocker (ARB)1
C Calcium-channel
blocker (CCB)
D Thiazide-like diuretic

A + C + D + consider further
diuretic3, 4 or alpha- or
beta-blocker5
Consider seeking expert advice

See slide notes for details of

footnotes 1-5

uan Hueim et al,Hypertension. Pathogenesis, risc factors

and prevention. 2010.


3 4

.
,

.

The ACCOMPLISH Trial

Systolic Blood Pressure Over

Time
ACEI / HCTZ
N=5733

CCB / ACEI
mm Hg

N=5713

130mmHg
Difference of 0.7 mmHg p<0.05*

129.3 mmHg

Month
Patients

5731
5709

5387
5377

5206
5154

4999
4980

*Mean values are taken at 30 months F/U visit

DBP: 71.1

DBP: 72.8

4804
4831

4285
4286

2520
2594

1045
1075

Kaplan Meier for Primary

Endpoint
Cumulative event rate

ACEI / HCTZ

20% Risk Reduction

650

CCB / ACEI
526

p = 0 .0 0 0 2

Time to 1st CV morbidity/mortality (days)

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

INTERIM RESULTS Mar 08

The PROGRESS study, a large-scale randomized trial

conducted among individuals with previous stroke or
tranSient ischemic attack, demonstrated that a flexible
blood-pressure-lowering regimen based on the ACE inhibitor
perindopril for all participants, with the addition
of the diuretic indapamide for the majority, not only
reduced the risk of stroke but also substantially reduced
the risks of major vascular events; cardiac outcomes, and
cognitive decline,


Tab 5 mg qd .


(Fatal and nonfatal CVD)

1% 3 =3%

 LDL
;

E .