JNC-8 & ESC

:

;

, M.D., Ph.D.(c)

...

1
57

.
:
1.
10 mg :
LDL 110 mg/dl, HDL 34 mg/dl, TG 114 mg/dl
2. ( 4)
3. 20 / 40
:
1. 2, ,
2.

1
:
1.
&
2. S1, S2 ,
3. ,

4.
5. : , ,

6. :
a)
b)
c)

: 152/85 mmHg
: 155/87 mmHg
: 160/90 mmHg (: 1.03, )

1
:

?
1.
2.
3.

<120

<80

120-129

80-84

130-139

85-89

140-159

90-99

160-179

100-109

180

110

140

<90

Mancia G, Fagard R, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial
hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal, 2013; 34:
2159-2219

140

90

135

85

120

70

130

80

135

85

24
( )
( )
24

:

Mancia G, Fagard R, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial
hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal, 2013; 34:
2159-2219

1
2 :
HBPM:
: 147.8 / 84.2 mmHg
: 151,3 / 87,1 mmHg

1
(),
()

1-2

(mmHg)

1
2

, 3,

, 4,



/

: , : , : , :
-
Mancia G, Fagard R, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial
hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal, 2013; 34:
2159-2219

1
2 :
H :
S/R 82 bpm

(+) Sokolow

1
2 :
Triplex :


MV & AV

1
57
, , ,

(),
()

&

&
&








&
1-2

&
&








&
&
3

&

&
&
&
, 3,

, 4,
&
&
&

: , : , : , :

1
:

?
1.
2.
3.
4.
5.
6.
7.
8.

24

/

Triplex &
K+, Na+, , ,

1, 4, 6

1

:


, HDL, LDL,
&

eGFR (MDRDC/G)

(dipstick ,
24, )
.
Mancia G, Fagard R, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial
hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal, 2013; 34:
2159-2219

1
,
,
:

&
24

holter

Mancia G, Fagard R, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial
hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal, 2013; 34:
2159-2219

1

(,
, ) -
,
.

Mancia G, Fagard R, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial
hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal, 2013; 34:
2159-2219

1
,
& 2 :
& HBPM:
: 145.1 / 81.2 mmHg
: 155,3 / 84,1 mmHg

:
0,9 eGFR 88 mL/min
24: 38 gr
AST 24, ALT 35, K+ 4.1, Na+ 138

1
:

?
1.
2.
3.
4.
5.
6.

AMEA ARB
CCB
Thiazide diuretic
B-Blocker
1+2
1+2+3

1
57
,

1
57
,
18

( ' )

& - , &

( )

> 60

< 60

<150 mm Hg
<90 mm Hg

<140 mm Hg
<90 mm Hg

ARB CCB

CCB, .

&

<140 mm Hg
<90 mm Hg

<140 mm Hg
<90 mm Hg

ARB,

. 1

1
57
,

1
57
,

2
45 ,
.
, , ,
,

.

:
1. 2
2. Hashimoto TSH:
1,2
3. SSRI
:
1.
2. Parkinson & Alzheimer

2
:
1.
2. S1, S2 & (102bpm),
3. ,

4.
5.
6. : , ,

7. :
a)
b)
c)

: 182/85 mmHg
: 185/87 mmHg
: 190/90 mmHg (: 0.97, )

2
:

?
1.
2.
3.
4.

,
, (WCH)
, (masked HT)
,

2
:

B 320mg A 5mg
N 5mg.
4


155/90 mmHg.

2
:

?
1.
2.

2
:
B 320mg, A 10mg, HCT 25mg
N 5mg
4


150/80 mmHg bpm 85.
,
,
(110-120 bpm), ,
160 mmHg.

2
:

?
1.
2.
3.
4.

Triplex
Triplex

24

. /

/ .

,
,
,

,
.

(
)

Cushing

,
,
,

,
,
, buffalo
hump

24

CT MRI
,

,,

, .
.

:
,

< 40

(

)

,

,
eGFR

U/S NOK

>
1.5
2 ,

eGFR (


)

Triplex

, spiral
,

per os,

, CT
,

3
80

20 Losartan 50 mg 1X1

(
2 , ).
:
1. 24
2. 98
.

3
:
1.
2. S1, S2 , 75 bpm
3. ,
4.
5.
6. :
a)
b)
c)

: 120/65 mmHg
: 115/60 mmHg
: 130/80 mmHg (: 1.1, )

7. HBPM: 110-130 mmHg & 60-70 mmHg

3
H :
S/R 72 bpm

(-) Sokolow

3
:

?
1.
2.

3
2 :

Triplex :

Triplex :

3
2 :

24: 80mg

o GFR: 59 mL/min

, 80 , LVH,
XNN ,

:
?
1. Losartan ABPM &
HBPM >160mmHg
2. Losartan CCB DU 140150mmHg
3. Losartan 120-140mmHg

, 80 , LVH,
XNN ,

:
?
1. Losartan ABPM
& HBPM >160mmHg
2. Losartan CCB DU 140150mmHg
3. Losartan 120-140mmHg

:
?
1. Losartan ABPM &
HBPM >160mmHg
140-150

:
?
1. Losartan ABPM &
HBPM >160mmHg
140-150

, 80 , LVH,
XNN ,

:
?
1. Losartan ABPM &
HBPM >160mmHg
2. Losartan CCB DU 140150mmHg
3. Losartan 120-140mmHg

:
?
2. Losartan CCB DU 140150mmHg

, 80 , LVH,
XNN ,

:
?
1. Losartan ABPM &
HBPM >160mmHg
2. Losartan CCB DU 140150mmHg
3. Losartan 120140mmHg

:
?
3. Losartan 120-140mmHg

:
?
3. Losartan 120-140mmHg

:
?
3. Losartan 120-140mmHg

:
?
3. Losartan 120-140mmHg

:
?

 JNC-8
& ESC
:

;