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v

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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.: , ,
,BMI:27
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

24 -

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,
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24 : ,
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24
:
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,

24 ..

(
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/
)
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ESH/ESC 2013

..

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

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
(),
()

(mmHg)
/


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, 3,

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-
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


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

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

1
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2.
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4.
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6.K+, Na+, , ,
7.
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&

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
H :
S/R 82 bpm

(+) Sokolow

1
2 :
Triplex :


MV & AV

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

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2.CCB
3.Thiazide diuretic
4.B-Blocker
5.1+2
6.1+2+3

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ESH/ESC2013

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.

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: 10mgr( LDL

39%)
O ,

2
68 7
.
:I 300/HCTZ25+A 10mgr
WBC:6600,Ht:42,2,PLT:189000
:93mg/dl,:47mg/dl,cr:1,04mg/dl,K/Na:3,9/138mEq/L
T-CHOL:205mg/dl,HDL:77,LDL:113,.:75mg/dl
:
1.2
2. Hashimoto TSH: 2,2
:
1. ,.. ...
2. Parkinson & Alzheimer

2
:
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2.S1, S2 & (85bpm),
3. ,

4.
5.
6.: , ,
,:29
7. ( 3 )
a)
b)

: 162/85 mmHg
: 165/87 mmHg

2
:

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1.
2.


.. { ..>140/90 mmHg}

3
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5-30%
<10%

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2 ,
Triplex

eGFR (

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, CT
,

U/S NOK

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,
,
,

,
.

(
)

Cushing


,
,
,

,
,
, buffalo
hump

24

CT MRI
,

2
ABPM:H:AVG:144/88mmHg
:77.8%>135mmHg/=23%>85mmHg
ABPM:N:146/72mmHg >120=100%/=67%>70mmHg
U/S : o /. 0,6
cm.A 12 cm
1,5 cm
Triplex : . . 30%
20% .
Triplex - :
60-70%.
60-70%
C/T :X
riplex :EF>60%,
24:25mgr/24,GFR:65ML/MIN/1.73m
:0,95

68
,


A
/



<2gr

( GFR>50mL/min)
30-45mins
24>100mEq


(
)
12,5-25mgr
A

2-3
/24 X,N,N,



160mgr/10mgr/HCTZ25 mgr
.
25mgr
20 mgr +ASA 100 mgr

BPM
,/,//
triplex
. stress-echo

, 68 , ,

: 163cm, : 88 kg, : 31kg/m2, W: 100cm


. .:
..: 165/95 mmHg

:
Glu: 115mg/dl , U:35 , Cr:0,90, eGFR:96,51 , TChol:257mg/dl
HDL: 34mg/dl
LDL: 149 mg/dl , TG: 220 mg/dl , UA: 8.4 mg%,
: (-),ALT:43,AST:40,-GT:39

: , (48 )
2

3
:
1.
2.S1, S2 , 75 bpm
3. ,
4.
5. s
6. HBPM: 155-145mmHg & 90-95mmHg

3
2 :

Triplex :

Triplex :

U/S :
,

3

5%-10% ..

160mgr/HCTZ12,5mgr
E 10 mgr

3
:

?
1.
2.


?
.
.
. -
ACEIs ARBs
. (-Blockers)

2013 ESH, ESC Guidelines:


Treatment strategies in hypertensive patients with
metabolic syndrome or prediabetes

G. Mancia et al EHJ June 2013

,


(/)

( , ).


-
300 mgr+
5mgr
E 40 mgr
E 2

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

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

:
?
2. Losartan CCB DU 140150mmHg

:
?
3. Losartan 120-140mmHg

:
?
3. Losartan 120-140mmHg

:
?
3. Losartan 120-140mmHg

:
?
3. Losartan 120-140mmHg

:
?

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

24 ..

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

/ )
ESH/ESC 2013

2
:

?
1.,
2., (WCH)
3., (masked HT)
4.,

, 68, ..

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

80

20 Losartan 50 mg 1X1

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

3
H :
S/R 72 bpm

(-) Sokolow

3
:

?
1.
2.


-

300 mgr
E 40 mgr
E 2

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