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Angiotensin converting enzyme inhibitor               ACEI
Angiotensin receptor blocker                          ARB
Body mass index                                       BMI
Calcium channel blocker                               CCB
Coronary heart disease                                CHD
Dietary approach to stop hypertension                 DASH
Diastolic blood pressure                              DBP
High-density lipoprotein cholesterol                  HDL-C
Low-density lipoprotein cholesterol                   LDL-C
Monoamine oxidase                                     MAO
Nonsteroid anti-inflammatory drug                     NSAID
Systolic blood pressure                               SBP
The Seventh Report of the Joint National Committee    JNC 7
on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure
Total cholesterol                                     TC
Triglyceride                                          TG




Aldosterone antagonist
Ambulatory blood pressure monitoring
Aneurysm
Antecubital fossa
Angioedema
Angiotensin converting enzyme inhibitor (ACEI)
Angiotensin receptor blocker (ARB)
Autonomic dysfunction
Bioavailability
Body mass index (BMI)
Brachial pulse
  -agonist
  -blocker
Catecholamine


                                                              1
Calcium channel blocker (CCB)
    Coronary heart disease (CHD)
    Corticotropin (ACTH)
    Conn's syndrome
    Cyclosporine
    Diastolic blood pressure (DBP)
    Dietary approach to stop hypertension (DASH) trial
    Doppler
    Dopamine
    Ductus arteriosus
    Erythropoietin (EPO)
    Episodic hypertension
    Epinephrine
    First dose effect
    Framingham study
    High-density lipoprotein cholesterol (HDL-C)
    Intrinsic sympathomimetic effect
    Isolated systolic hypertension
    Licorice
    Low-density lipoprotein cholesterol (LDL-C)
    Microalbuminuria
    Mineralocorticosteroid
    Monoamine oxidase (MAO) inhibitors
    Nonsteroid anti-inflammatory drug (NSAID)
    Norepinephrine
    Phase 1
    Phase 5
    Prehypertension
    Renin
    Systolic blood pressure (SBP)
    Target organ
    Total cholesterol (TC)
    Triglyceride (TG)
    Tyramine
    White-coat hypertension
    Withdrawal syndrome



2
-

                               WHO ISH
Guideline,1999
         7       JNC7   2003




                                         3
2002
           15                   24.9%      18.2%    65
                        56.6%




                      40%         25%                 50%

                                                    2002
                                    59%     79%
          47%   64%                           21%
    29%




4
contents
                                   contents

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

                                   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

                                                 . . . . . . . . . . . . . . . . . . . . . . .10

             . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

                                       . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

                                   . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

                                             . . . . . . . . . . . . . . . . . . . . . . . . .38

                       . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56

                                         . . . . . . . . . . . . . . . . . . . . . . . . . . .74

                                                                                            .87

                                       . . . . . . . . . . . . . . . . . . . . . . . . . . . .90

                 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

                                                                                                     5
147.7
                  156.8   1-1
                          152.9
          152.3




    1-1




6
40%                   25%                   50%




 (1)


 (2)


 (3)


 (4)
 (5)                                                 angiotensin
       receptor blocker
 (6)           (The Seventh Report of the Joint National Committee
       on Prevention, Detection, Evaluation, and Treatment of High
       Blood Pressure, the JNC 7)
       (1999 World Health Organization-International Society of
       Hypertension Guidelines for the Management of Hypertension
       & ESH Updates)




                                                                     7
(1)
                              120/80 mmHg                     130/85
          mmHg           120    139 mmHg        80 89 mmHg




    (2)
                                              115/75 mmHg
                 20/10 mmHg
    (3)                                                (   140 mmHg)




    (4)                                           DASH




    (5)
                                            thiazide




    (6)


8
140/90 mmHg
      130/80 mmHg
                    20/10 mmHg
                            thiazide


(1)
(2)
(3)




                                                     9
JNC 7    2003
                                                 140 mmHg     /        (diastolic
     blood pressure, DBP)                 90 mmHg
                   120 mmHg                   80 mmHg
                                    prehypertension     2-1         JNC 7
                                                                  140-159 mmHg
       /          90-99 mmHg
           160 mmHg        /                        100 mmHg




                     2-1       18

                                            (mmHg)                     (mmHg)

                                          <120                        <80

              (prehypertension)          120-139                      80-89

                                         140-159                      90-99

                                            160                        100




             95                               2-2



10
2-2


                     ( 90-94        )   ( 95-99      )     (    99     )
          (SBP)
  7                                        96-105                106
  8-30                                     104-109               110
      2
  SBP                     104-111          112-117               118
  DBP                      70-73            74-81                82
3-5
  SBP                     108-115          116-123               124
  DBP                      70-75            76-83                84
6-9
  SBP                     114-121          122-129               130
  DBP                      74-77            78-85                86
10-12
  SBP                     122-125          126-133               134
  DBP                      78-81            82-89                90
13-15
  SBP                     130-135          136-143               144
  DBP                      80-85            86-91                92
16-18
  SBP                     136-141          142-149               150
  DBP                      84-91            92-97                98

          Systolic blood pressure, SBP                   Diastolic blood
          pressure, DBP                                  mmHg



                                                                           11
210/120 mmHg




             10




       23


                                            2-1
                            120/80 mmHg


                    JNC 7




                                             115/75
     mmHg                         20 mmHg         10
     mmHg




12
2-1




                              96%




       JNC 7                         5000
                10
             1993-1996
                                26%              19%
                  2002                            15
                     24.9%          18.2%




2002                     18    30                 30
                                            60
                 2-2


                                                       13
30                  60                        2-
     3
     1989-1991                       65
                 36.9
                        2002                    65
                        56.6%
                                                     40
                  60
         2002                                   60
                  60                           2-4
                 1990




                           1993-1996




                                          46




14
2-2     15




                                                        2002


        2-3     15




                                                        2002


  2-4     15




<20     20-29   30-39   40-49   50-59   60-69   70-79    80+



                                                        2002

                                                               15
140 mmHg      90 mmHg
                             (   120-139 mmHg
     80-89 mmHg)




            (        )




16
3-1




           (cuff)                                           12.5


(   3-1)                           (inner bag)
                                                      80%


                            3-1



                      1                          2.5

                      1-3                        5-6

                      4-8                        9-10

                                                 12.5

                                                 14



                                  3-1




                                                                   17
(             2
       )




                                    (antecubital fossa)
     (brachial pulse)(   3-2)
                             20~30 mmHg                                  2~3 mmHg


                         (phase 1         )
                                         (phase 5              )


                                Nicolai S. Korotkoff   1905
                                                    (muffling                )




                                                                   2~3


           5 mmHg




18
3-2




                                                      21




             (               210 mmHg     120 mmHg)


                 3-2


                 3-2    18                    *
                       (mmHg)                     *


     < 120                         < 80
    120 - 139                   80 - 89
    140 - 159                   90 - 99
    160 - 179                 100 - 109
      ≥180                         ≥110
*

                                                           19
(ambulatory blood
           pressure monitoring)      3-3


                         3-3




                                                             10-
     20%


     white-coat hypertension
                             episodic hypertension
     autonomic dysfunction


                       135/85 mmHg




20
115/75 mmHg    185/115 mmHg                    20 mmHg
10 mmHg
          140-159 mmHg              90-99 mmHg
             12 mmHg
                                                Framingham Study
                        50                                      140
mmHg
                                    isolated systolic hypertension




                       coronary heart disease, CHD
                              CHD
       CHD                                     CHD




                                                                      21
5 mmHg




                                                     140/90
     mmHg
     1999-2000         JNC 7
                                     1993   1996


                                     43%       53%
                 31%           45%


22
15%    22%         2002
                   59%   79%
47%    64%                      21%
29%




                                      23
96   99


               5-1




24
1
              2
                  3
     4




1.




2.
         14




                          25
5   2.5


          6         2.4




     3.




     4.




     5.




     6.




26
5-1




1.




2.
                          (A)
           (B)            (C)


 (1)
                 30   g



                                27
15 mmHg
                       7      10 mmHg




      (2)       (licorice)    carbenoxolone (
                        )
            (mineralocorticosteroid)




      (3)                                 (corticotropin, ACTH)




      (4)                           (nonsteroid anti-inflammatory drug,
            NSAID)           indomethacin
      (5)                             phenylpropanolamine
            (catecholamine)


                                 (MAO inhibitor)   pargyline
                             (tyramine)




     3.


28
4.
                  ductus arteriosus




5.
     Conn's syndrome




                                      29
()
     ()
     ()         (target organ)                 ( 5-2)

          5-2          (target organ)




                                         50%

                         aneurysm

                                 1.5 mg/dL

                       1(+)

                         microalbuminuria




30
(cyclosporine)                 (erythropoietin, EPO)
             (MAO inhibitor)

                                                       31
1.




     2.




32
3.




     5-3




           33
5-3

     (1)




     (2)




             X



     (3)




            (catecholamine)




       1.




34
(1)




               Sokolow-Lyon               V5   V6
      R   V1    S             35   (mV)




(2)




(3)




(4)


(5)




                                                    35
(6)




     (7)




     (8)




     2.




     3.




     (1)


           (Doppler)




36
(2)




      (renin)




        24              (catecholamine)
                                 (norepinephrine)
        (epinephrine)     (dopamine)




                                                    37
2003       JNC 7




                                                        6-1


                   6-1                                                                  *


                                         (BMI1 18.5 23.9)                          10
                                                                                   5 20 mmHg
           DASH2
                                                                             8 10 mmHg


                                                             2.4 g           2   8 mmHg
                            ( 6g         )
                                                                             4 9 mmHg
                                         3             30


                                                             30cc            2   4 mmHg
                                                                 15
                          cc(30cc                    720cc
                            300 cc           60cc            )

                                                                                               )
     *
         BMI                    [    (        )]/[       (            )] 2
     1


         DASH   Dietary Approach to Stop Hypertension,
     2


                   2100     /

38
(body mass index, BMI)




                                            BMI
                                  BMI                          18.5~23.9
18.5                        24                                 27
30                          35                    BMI                  30
                                                                            BMI
                                      BMI
            BMI                                       6-2.1         6-2.2


              6-2.1                         BMI

                                                  (                         )
                  BMI (Body Mass Index)                                     2
                                                  (                         )

                                  (                   )2        22
                        (    10%                           )

                                                                                90
       80

                                                                                     39
6-2.2              (BMI)



     (     )
     150       41.6   41.6 54.0   54.0   60.8    67.5   78.8

     151       42.2   42.2 54.7   54.7   61.6    68.4   79.8

     152       42.7   42.7 55.4   55.4   62.4    69.3   80.9

     153       43.3   43.3 56.2   56.2   63.2    70.2   82.0

     154       43.9   43.9 56.9   56.9   64.0    71.1   83.0

     155       44.4   44.4 57.7   57.7   64.9    72.1   84.1

     156       45.0   45.0 58.4   58.4   65.7    73.0   85.2

     157       45.6   45.6 59.2   59.2   66.6    73.9   86.3

     158       46.2   46.2 59.9   59.9   67.4    74.9   87.4

     159       46.8   46.8 60.7   60.7   68.3    75.8   88.5

     160       47.4   47.4 61.4   61.4   69.1    76.8   89.6

     161       48.0   48.0 62.2   62.2   70.0    77.8   90.7

     162       48.6   48.6 63.0   63.0   70.9    78.7   91.9

     163       49.2   49.2 63.8   63.8   71.7    79.7   93.0

     164       49.8   49.8 64.6   64.6   72.6    80.7   94.1

     165       50.4   50.4 65.3   65.3   73.5    81.7   95.3

     166       51.0   51.0 66.1   66.1   74.4    82.7   96.4



40
167   51.6   51.6 66.9   66.9   75.3   83.7    97.6

168   52.2   52.2 67.7   67.7   76.2   84.7    98.8

169   52.8   52.8 68.5   68.5   77.1   85.7    100.0

170   53.5   53.5 69.4   69.4   78.0   86.7    101.2

171   54.1   54.1 70.2   70.2   79.0   87.7    102.3

172   54.7   54.7 71.0   71.0   79.9   88.8    103.5

173   55.4   55.4 71.8   71.8   80.8   89.8    104.8

174   56.0   56.0 72.7   72.7   81.7   90.8    106.0

175   56.7   56.7 73.5   73.5   82.7   91.9    107.2

176   57.3   57.3 74.3   74.3   83.6   92.9    108.4

177   58.0   58.0 75.2   75.2   84.6   94.0    109.7

178   58.6   58.6 76.0   76.0   85.5   95.1    110.9

179   59.3   59.3 76.9   76.9   86.5   96.1    112.1

180   59.9   59.9 77.8   77.8   87.5   97.2    113.4

181   60.6   60.6 78.6   78.6   88.5   98.3    114.7

182   61.3   61.3 79.5   79.5   89.4   99.4    115.9

183   62.0   62.0 80.4   80.4   90.4   100.5   117.2

184   62.6   62.6 81.3   81.3   91.4   101.6   118.5

185   63.3   63.3 82.1   82.1   92.4   102.7   119.8




                                                       41
BMI


                 10%




     Dietary Approach to Stop Hypertension trial, DASH trial   1997


                                                           2
                              6
                                DASH                 6-3




                                                    DASH
          6-4



42
6-3                  DASH
                       * DASH

                                             DASH
    1.                     /
                                1.6          5.2
                                2.0          4.4
                                8.2          7.5
                                0.1          2.0
                                0.4          0.7
                                0            0.7
                                1.5          0.5
                                0.8          0.6
                                0.2          0.5
                                5.8          2.5
                                4.1          0.7
    2.
                                37           27
                                16           6
                                13           13
                                8            8
                                48           55
                                15           18
                 /              300          150
             /                  19           31
         /                      1700         4700
         /                      165          500
         /                      450          1240
         /                      3000         3000

*        2100


                                                    43
6-4    DASH




        7-8   1



        4-5   1

              6 oz

        4-5   6 oz

              1

              1/4



        2-3   8 oz      1            1%

              1.5 oz

        2     3 oz



        1-2   1.5 oz    1/3    2




     DASH




44
10 mmHg




                                                              6-5
 6-6      6-7                                         6-8


                      6-5
                           100                        100
                  (   )(           )         (   )(            )
                111          2.8            256             6.6
                135          3.5            270             6.9
                142          3.6            274             7.0
                151          3.9            279             7.2
                154          3.9            293             7.5
                166          4.2            322             8.2
                196          5.0            326             8.4
                203          5.2            349             8.9
                221          5.7            350             9.0
                221          5.7            398             10.2
                222          5.7            416             10.7
                228          5.8            420             10.8
                234          6.0            461             11.8
                235          6.0            469             12.0
                238          6.0            546             14.0
                245          6.3       ()   1482            38.0
A               254          6.5            193             4.9
                65           1.5            207             5.3
    ()          102          2.6            214             5.5
                111          2.8            221             5.7
    ()          112          2.9            245             6.3
                125          3.2            291             7.5
                130          3.3            315             8.1
                135          3.5            323             8.3
                167          4.3            401             10.3
                170          4.4            495             12.7
                176          4.5            536             13.7
                181          4.6

                                                                    45
6-6


     (        /100    )

         50    100




         101    200

                                          ()




         201    300

         301    400

              400

                              ()




                              6-7


                 (        )         599   250

                                    445   238

                 (        )         444   231

                                    434   230

                                    418   219

                                    379   189


46
318              177

              294              169

              283    ()        163

              281              162

              280              153

              250




        6-8

                            /100



100.0         32.5   45.4            17.6

100.0         39.6   44.3            11.8

100.0         48.2   42.3             4.2

100.0         86.0    6.0             2.0

100.0         47.9   38.4             9.3

100.0         17.0   47.0            31.0

100.0         15.2   40.0            40.5

100.0         15.0   23.1            57.6

100.0         12.7   24.7            58.2

100.0         10.2   20.9            63.8

100.0          9.4   12.5            73.8

 80.0         49.3   23.1             3.0




                                            47
11
     mmHg




       JNC 7   2.4     6




                     6-9



48
6-10                     6-11        6-1


         6-9



         (          )/                         100

                                           (   100   )




              100



       6-10




                                1.




                                                         49
2.




     3.




     1.




     2.



     3.




     1.



     2.



     3.


50
1.




                          2.




       6-11
 1            2
2000          5
 1            1 1/5           6
 1/5          1       3
              1       5
              2 1/2               12
              2                10
              2/5         2


                                       51
6-1




     220           /    60   80%
                                   10 mmHg




           JNC 7                             30


52
210
                 0.6 g/kg
                                            30 cc
   30 cc                 720 cc        300 cc              200 cc
60 cc          60 cc
                            30 cc                   6-12


        6-12                        30 cc              cc.

                                            30 cc             (cc.)

                       16.50%                              180

                         15%                               200

                         15%                               200

                       10.50%                              290

                         34%                                90

                       28.50%                              100

                         35%                                90

                         54%                                60

                       19.50%                              150

                       4.50%                               670


                                                                      53
withdrawal syndrome




     1.6




54
55
JNC 7

      140/90 mmHg

                    140/90 mmHg




     130/80 mmHg




                          7-1




56
7-1




                                          (<140/90
                          mmHg
                                    <130/80mmHg




                                      (
             (
                           160 mmHg
140-159 mmHg                                                    (ACEI,
  90-99 mmHg)                                        ARB, diuretics, -
      thiazide                                       blockers, CCB
                           thiazide
                           ACEI ARB            -
ACEI, ARB,   -blockers,    blockers, CCB
CCB




                                140-159 mmHg            90~99 mmHg


                                                                         57
160 mmHg                       100 mmHg




                                           angiotensin converting enzyme inhibitor,
     ACEI                                        angiotensin receptor blocker, ARB
                                       -blocker                                   calcium
     channel blocker, CCB               thiazide
                               7-1                                                   7-2
                                           7-3




                             7-1

     Class-               Drug (Trade Name)-         (     )   Usual Dose Range Daily

                                                                  mg/d-       Frequency-



     Thiazide diuretics   Chlorothiazide (Diuril)              125-500        1

                          Chlorthalidone (generic)             12.5-25        1

                          Hydrochlorothiazide(Microzide,       12.5-50        1

                          HydroDIURIL)+

                          Polythiazide(Renese)                 2-4            1

                          Indapamide(Lozol, Natrilix)+         1.25-2.5       1

                          Metolazone(Mykrox)                   0.5-1.0        1

                          Metolazone(Zaroxolyn)                2.5-5          1

     Loop diuretics       Bumetanide(Bumex, Burinex)+          0.5-2          2

                          Furosemide(Lasix)+                   20-80          2

                          Torsemide(Demadex)+                  2.5-10         1

58
Potassium-          Amiloride(Midamor)+                   5-10      1-2

sparing diuretics

                    Triamterene(Dyrenium)                 50-100    1-2

Aldosterone-        Eplerenone(Inspra)                    50-100    1-2

receptor blockers

                    Spironolactone(Aldactone)+            25-50     1-2

  -Blockers         Atenolol(Tenormin)+                   25-100    1

                    Betaxolol(Kerlone)+                   5-20      1

                    Bisoprolol(Zebeta)+                   2.5-10    1

                    Metoprolol(Lopressor, Betaloc)+       50-100    1-2

                    Metoprolol extended release           50-100    1

                    (Toprol XL)

                    Nadolol(Corgard)+                     40-120    1

                    Propranolol(inderal)+                 40-160    2

                    Propranolol long-acting(InderalLA)+   60-180    1

                    Timolol(Blocadren)+                   20-40     2

  -Blockers with    Acebutolol(Sectral)+                  200-800   2

  intrinsic

 sympathomimetic

 activity

                    Penbutolol(Levatol)                   10-40     1

                    Pindolol(generic)                     10-40     2

Combined            Carvedilol(Coreg, Dilatrend)          12.5-50   2

 -and -blockers

                    Labetalol(Normodyne, Trandate)+       200-800   2




                                                                          59
ACE inhibitors     Benazepril(Lotensin)+            10-40     1-2
                        Captopril(Capoten)+              25-100    2
                        Enalapril(Vasotec, Renitec)+     2.5-40    1-2
                        Fosinopril(Monopril)             10-40     1
                        Lisinopril(Prinivil, Zestril)+   10-40     1
                        Moexipril(Univasc)               7.5-30    1
                        Perindopril(Aceon)               4-8       1-2
                        Quinapril(Accupril)              10-40     1
                        Ramipril(Altace, Tritace)        2.5-20    1
                        Trandolapril(Mavik)              1-4       1
     Angiotensin P      Candesartan(Atacand Blopress)    8-32      1
     receptor blocker   Eprosartan(Tevetan)              400-800   1-2
                        Irbesartan(Aprovel)              150-300   1
                        Losartan(Cozaar)                 25-100    1-2
                        Olmesartan(Benicar)              20-40     1
                        Telmisartan(Micardis)            20-80     1
                        Valsartan(Diovan)                80-320    1
     Calcium channel    Diltiazem extened release(       180-420   1
     blockers-          Cardizem CD, Dilacor XR,
     non-               Tiazact)+
     dihydropyridines
                        Diltiazem extended release(      120-540   1
                        Cardizem LA)
                        Verapamil immediate release(     80-320    2
                        Calan, Isoptin)+
                        Verapamil long-acting(Calan      120-360   1-2
                        SR, Isoptin SR)+
                        Verapamil-coer(Covera HS,        120-360   1
                        Verelan PM)


60
Calcium channel      Amlodipine(Norvasc)              2.5-10         1

blockers-            Felodipine(Plendil)              2.5-20         1

dihydropyridines

                     Isradipine(Dynacirc CR)          2.5-10         2

                     Nicardipine sustained release    60-120         2

                     (Cardene SR)

                     Nifedipine long-acting (Adalat   30-60          1

                     CC, Procardia XL)

                     Nisoldipine(Sular)               10-40          1

    -Blockers        Doxazosin(Cardura, Doxaben)      1-16           1

                     Prazosin(Minipress)              2-20           2-3

                     Terazosin(Hytrin)                1-20           1-2

Central     -        Clonidine(Catapres)              0.1-0.8        2
            2


agonists and         Clonidine patch(Catapres TTS)    0.1-0.3        1 weekly

other centrally

acting drugs

                     Methyldopa(Aldomet)              250-1000       2

                     Reserpine(generic)               0.05-0.25      1#

                     Guanfacine(generic)              0.5-2          1

Direct               Hydralazine(Apresoline)+         25-100         2

vasodilators         Minoxidil(Loniten)+              2.5-80         1-2


    Abbreviation: ACE, angiotensin-converting enzyme.
* Dosages may vary from those listed in the Physicians Desk Reference. Which
    may be consulted for additional information.
    Are now or will soon become available in generic preparations.
+



    A 0-1 mg dose may be given every other day to achieve this dosage.
#




                                                                                61
7-2




     Thiazides




     Loop diuretics           thiazides



     Potassium-                                                  ACE   NSAID

     sparing agents



     Spironolactone

     Triamterene

     Amiloride
                  (                   )

     Acebutolol

     Atenolol

     Betaxolol

     Bisoprolol

     Carteolol                      HDL              (pindolol

     Metoprolol               acetbutolol       )

     Pindolol

     Propranolol

     Timolol

                      ( -1-     )

     Prazosin                               (first doseeffect)

     Terazosin


62
(             )

Labetalol




Vasodilators



Hydralazine      Antinuclear antibody(ANA)



Minoxidil




Captopril

Cilazapril

Enalapril

Fosinopril

Lisinopril

Quinapril




Candesartan

Eprosartan

Irbesartan


                                             63
Losartan                  (           )

     Olmesartan                        (            )

     Telmisartan

     Valsartan                 (

                                       )




     Verapamil

     Diltiazem

     Nifedipine

     Nicardipine

     Felodipine

     Amlodipine

     Isradipine




     Clonidine



                                   -

     Methyldopa    clonidine



                                           catecholamine



     Guanabenz

     Guanfacine




64
Guanadrel

sulfate

Guanethidine

monosulfate

Rauwolfia

alkaloids

Reserpine




                     7-3




               Cholestyramine colestipol                  Aldosterone

                                             thiazides

                                             furosemide

               NSAID(      aspirin

                 )



               NSAID           -           Cimetidine       diltiazem verapamil



               Rifampin phenobarbital




                                           Quinidine        reserpine




                                                                                  65
theophylline lidocaine

                                                     chlorpro-mazine

                                                                     (

                                                   phenylpropanolamine

                                                   ephedrine pseudoephedrine

                                                   ) epine-phrine

                                                             (    receptor

                                                       )

      -

                                     (         )




     ACE   NSAID(      aspirin   )           ACE

                                                     NSAID

                                     (   )

                         ACE



           (bioavailability)


66
NSAID(      aspirin          )
                                              (     NSAID
                                   )


                                 Cimetidine       Verapamil         digoxin
                                                  carbamazepine
  rifampin verapamil                                            diltiazem
carbamazepine diltiazem
verapamil phenobarbital                           Verapamil
phenytoin verapamil                               prazosin theophylline


                                                  Cyclosporine


     guanethidine
ephedrine amphetamine                               clonidine


                                                  Methyldopa




             phenothiazine




Monoamine oxidase
inhibitors (MAO        )
                  tyramine



                                                                              67
norepinephrine
                                 reserpine
                  guanethidine




                clonidine guanabenz




             thiazide


               thiazide




     ()
                                                          thiazide
                                                       Treatment to Prevent
     Heart Attack trial     Anti-Hypertension and Lipid-lowering trial   thiazide


                   The Second Australian National Blood Pressure trial
                                             ACE




68
thiazide


                                  thiazide         ACEI
ARB        -blocker   CCB




()


                                             7-4




                7-4



                            ACE




                                                          69
()




                                                  20/10 mmHg
                                                                                  7-5




                                   7-5

     Combination Type     Fixed-Dose Combination, mg*                             Trade Name
     ACE inhibitors and   Amlodipine/benazepril hydrochloride(2.5/10,5/10,5       Lotrel
     CCBs                 /20,10/20)
                          Enalapril maleate/felodipine (5/5)                      Lexxel
                          Trandolapril/verapamil (2/180,1/240,2/240,4/240)        Tarka
     ACE inhibitors and   Benazepril/hydrochlorothiazide (5/6.25,10/12.5,50/      Lotensin HCT
     diuretics            15,50/25)
                          Captopril/hydrochlorothiazide (25/15,25/25,50/15,       Capozide
                          50/25)
                          Enalapril maleate/hydrochlorothiazide (5/12.5,10/25) Vaseretic


                          Lisinopril/hydrochlorothiazide (5/12.5,20/12.5,20/25)   Prinzide
                          Moexipril HCI/hydrochlorothiazide (7.5/12.5,15/25)      Uniretic
                          Quinapril HCI/hydrochlorothiazide (10/12.5,20/12.5,     Accuretic
                          20/25)
     ARBs and diuretics   Candesartan cilexetil/hydrochlorothiazide (16/12.5,32 Atacand HCT
                          /12.5)
                          Eposartan cilexetil/hydrochlorothiazide (600/12.5,600 Teveten HCT


70
/25)
                     Irbesartan/hydrochlorothiazide (75/12.5,150/12.5,300 Avalide
                     /12.5)
                     Losartan potassium/hydrochlorothiazide (50/12.5,100 Hyzaar
                     /25)
                     Telmisartan/hydrochlorothiazide (40/12.5,80/12.5)        Micardis HCT
                     Valsartan/hydrochlorothiazide (80/12.5,160/12.5)         Diovan HCT
   -Blockers and     Atenolol/chlorthalidone (50/25,100/25)                   Tenoreic
diuretics            Bisoprolol fumarate/hydrochlorothiazide (2.5/6.25,5/     Ziac
                     6.2510/6.25)
                     Propranolol tartrate/hydrochlorothiazide (40/25,80/25)   Inderide
                     Metoprolol tartrate/hydrochlorothiazide (50/25,100/25)   Lopressor HCT
                     Nadolol/bendrofluthiazide (40/5,80/5)                    Cozide
                     Timolol maleate/hydrochlorothiazide (10/25)              Timolide
Centrally acting     Amiloride HCI/hydrochlorothiazide (250/15,250/25,        Aldoril
grug and diuretic    500/30,500/50)
                     Reserpine/chlorothiazide (0.125/250,0.25/500)            Diupres
                     Reserpine/hydrochlothiazide                              Hydropres
Diuretic and diuretic Amiloride HCI/hydrochlorothiazide (5/50)                Moduretic
                     Spironolactone/hydrochlorothiazide (25/25,50/50)         Aldactone
                     Triamterene/hydrochlorothiazide (37.5/25,50/25,75        Dyazide.
                     /50)                                                     Maxzide
 Abbreviations:ACE angiotensin-converting enzyme:ARB, angiotensin-receptor
 blocker,CCB,calcium channel blocker,HCI,hydrochloride,HCT,hydrochlorothiazide,LA, long-
 acting.
* Some drug combinations are available in multiple fixed doses. Each drug dose is reported
 in milligrams.



                                                                                              71
()




                                (serum potassium   K)
      (creatinine   Cr)




                      Aspirin




          7-6




72
7-6

(1)
(2)
  a.
  b.
  c.
  d.




                NSAID




(3)




(4)




(5)


        30 cc

                        73
140 mmHg           90 mmHg




     guanethidine    guanadrel      -1        labetalol




                    95




                                         (Doppler)




74
ACE




      2   3




              75
(1)        (2)            (3)
     (4)




                                            140/90 mmHg
                      30 mmHg             15 mmHg
           140/90 mmHg
                                6 mg/dL


           1.




                                                    ACE




           methyldopa
           ACE


           2.




76
100 mmHg
                methyldopa
hydralazine                                    -   -
                                    hydralazine
                furosemide




                             nifedipine   clonidine




                                                       77
>220 mmHg         >120
     mmHg




                            220 mmHg            120
     mmHg
                 10   15%                ACE
     thiazide




                                   ACE
                ACE




78
ACE
                           loop
     ACE




hydralazine   minoxidil




                                  79
ACE
                                                                          ACE


                                             130/80                mmHg


                                                              -1




                    /                                         ACE


                                                      -   -




                              phenylpropanolamine


     guanethidine       reserpine

80
-
agonist




                            total cholesterol , TC
      high-density lipoprotein cholesterol, HDL-C
    low-density lipoprotein cholesterol, LDL-C
 triglyceride, TG                                                   8-
1


      Thiazide    loop                                      LDL-C




 HDL-C
                              intrinsic sympathomimetic effect




labetalol


        -1-
          LDL-C
        ACE



                                                                         81
8-1
                                        2          TC/HDL-C
                                            =(     5 HDL-C
                                                 )  40 mg/dL
                                                       X
                                            V
                           200 mg/dL                                200 mg/dL
                     TC
                           240 mg/dL                   X
                                            X                       240 mg/dL
                                            V          X
                          130 mg/dL                                 130 mg/dL
                 LDL-
                     C                                              160 mg/dL
                                            X          X
                          160 mg/dL
                     TG 200 mg/dL
     (




                                                                       200
                      (
                                            X          V             mg/dL
                     TC/HDL-C 5
                                                                    (87/4/1)
                        HDL-C 40
     )




                         mg/dL)
                                                                       160
                                            X          X
                     TC 200 mg/dL                                    mg/dL
                                                                    (87/7/1)
                                                                       100
                      LDL-C 130
                                            X          X             mg/dL
                        mg/dL
                                                                    (87/7/1)
                     TG 200 mg/dL
                                                                       150
                      (
                                            X          V             mg/dL
                     TC/HDL-C 5
                                                                    (87/7/1)
                        HDL-C 40
                         mg/dL)

                               1000 mg/dL                                       (87/4/1)


     1.
          (1)
          (2)
          (3)
     2.
          (1)
          (2)
          (3)                                                            70%
     3.

     1.         2.        3.        45 4.                      5.         55
     6.


82
Thiazide
                                       (   :allopurinol)
         (         probenecid)
                                  thiazide




                                 (1)                       60 ml/min/1.73 m2
(                       1.5 mg/dL                          1.3 mg/dL)     (2)
                 300 mg                                                     200
mg/gm
    130/80 mmHg
     ACE
                                                    35


             ACE
                                                    30 ml/min/1.73 m2 (
         2.5    3.0 mg/dL)                   loop




                                                                                  83
(           30)
                                                           (
             90                80   BMI   24)              (
                  110 mg/dL)         130/85 mmHg               (
            150 mg/dL)                          (   40 mg/dL
           50 mg/dL)




                                10 mmHg


       (                 -            )




     (norepinephrine)




84
-        (      phentolamine)




                                        (
                              )


    (Cyclosporine)


                                            50   70


                 labetalol    clonidine
    diltiazem   nicardipine       verapamil




                                                      85
(          7-2)


     Thiazide
                               (         )
                               Raynaud
                 -


     Thiazide
                                                     ACE
                                             ACE
                (angioedema)           5 mEq/L




86
(       )


      (         120-139 mmHg         80-89 mmHg)
      JNC 7


                                               5 mmHg
          14%                   9%                  7%




(1)


(2)
(3)                         (              )


(4)

                                                         87
(5)
     (6)




     (1)   (   )


                   (
                       )




88
(2)




          (           )




                  (       )




      (       )




                              89
90
1. American Diabetes Association. Treatment of hypertension in adults
   with diabetes. Diabetes Care. 2003;26(suppl 1):S80-S82.

2. Black HR, Elliott WJ, Grandits G, et al. Principal results of the
   Controlled Onset Verapamil Investigation of Cardiovascular End
   Points (CONVINCE) trial. JAMA. 2003;289:2073-2082.

3. Blood Pressure Lowering Treatment Trialists      Collaboration. Effects
   of ACE inhibitors, calcium antagonists, and other blood-pressure-
   lowering drugs: results of prospectively designed overviews of
   randomized trials. Lancet. 2000;256:1955-1964.

4. Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on
   renal and cardiovascular outcomes in patients with type 2 diabetes
   and nephropathy. N Engl J Med. 2001;345:861-869.

5. Chien KL, Sung FC, Hsu HC, Su TC, Lee YT. Left ventricular mass
   and correlated atherosclerotic risk factors in young adolescents:
   report from Chin-Shan community cardiovascular study in Taiwan.
   Atherosclerosis. 2001;155:431-437.

6. Chobanian AV, Bakris GL, Black HR, et al. Joint National Committee
   on Prevention, Detection, Evaluation, and Treatment of High Blood
   Pressure. National Heart, Lung, and Blood Institute; National High
   Blood Pressure Education Program Coordinating Committee.
   Seventh report of the Joint National Committee on Prevention,
   Detection, Evaluation, and Treatment of High Blood Pressure.
   Hypertension. 2003;42:1206-1252.

7. Chobanian AV, Bakris GL, Black HR, et al. National Heart, Lung, and
   Blood Institute Joint National Committee on Prevention, Detection,



                                                                             91
Evaluation, and Treatment of High Blood Pressure; National High
        Blood Pressure Education Program Coordinating Committee. The
        Seventh Report of the Joint National Committee on Prevention,
        Detection, Evaluation, and Treatment of High Blood Pressure: the
        JNC 7 report. JAMA. 2003;289:2560-2572.

     8. Dahlof B, Devereux RB, Kjeldsen SE. et al. Cardiovascular morbidity
        and mortality in the Losartan Intervention For Endpoint Reduction in
        Hypertension Study (LIFE). Lancet. 2002;359:995-1003.

     9. Guidelines Subcommittee: 1999 World Health Organization-
        International Society of Hypertension guidelines for the management
        of hypertension. J Hypertens. 1999;17:151-183.

     10. Guidelines Committee. 2003 European Society of Hypertension-
        European Society of Cardiology guidelines for the management of
        arterial hypertension. J Hypertens. 2003;21:1011-1053.

     11. Kjeldsen SE, Erdine S, Farsang C, Sleight P, Mancia G; 1999
        WHO/ISH Hypertension Guidelines subcommittee. 1999 WHO/ISH
        Hypertension Guidelines--highlights & ESH update. J Hypertens.
        2002;20:153-155.

     12. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific
        relevance of usual blood pressure to vascular mortaility. Lancet.
        2002;360:1903-1913.

     13. Lee YT, Lin RS, Sung FC, Yang CY, Chien KL, Chen WJ, Su TC, Hsu
        HC, Huang YC. Chin-Shan Community Cardiovascular Cohort in
        Taiwan-baseline data and five-year follow-up morbidity and mortality.
        J Clin Epidemiol. 2000;53:838-846.

     14. Lewis WJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of
        the angiotensin-receptor antagonist irbesartan in patients with



92
nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851-
   860.

15. National Kidney Foundation Guideline. K/DOQI clinical practice
   guidelines for chronic kidney disease: kidney Disease Outcome
   Quality Initiative. Am J Kidney Dis. 2002;39(suppl 2):S1-S246.

16. National Cholesterol Education Program. Third Report of the National
   Cholesterol Education Program (NCEP) Expert Panel on Detection,
   Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
   Treatment Panel III) final report. Circulation. 2002;106:3143-3421.

17. National High Blood Pressure Education Program. Report of the
   National High Blood Pressure Education Program Working Group on
   high blood pressure in pregnancy. Am J Obstet Gynecol.
   2000;183:S1-S22.

18. National High Blood Pressure Education Program Working Group on
   Hypertension Control in Children and Adolescents. Update on the
   1987 Task Force Report on high blood pressure in children and
   adolescents. Pediatrics. 1996;98:649-658.

19. Pan WH, Chang HY, Yeh WT, Hsiao SY, Hung YT. Prevalence,
   awareness, treatment and control of hypertension in Taiwan: results
   of Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996. J
   Hum Hypertens. 2001;15:793-798.

20. Pitt B, Remme W, Zannad F. et al. Eplerenone a selective
   aldosterone blocker, in patients with left ventricular dysfunction after
   myocardial infarction. N Engl J Med. 2003;348:1309-1321.

21. Sacks FM, Svetkey LP, Vollmer WM, et al, for the DASH-Sodium
   Collaborative Research Group. Effects on blood pressure of reduced
   dietary sodium and the Dietary Approaches to Stop Hypertension



                                                                              93
(DASH) diet. N Engl J Med. 2001;344;3-10.

     22. Su TC, Jeng JS, Chien KL, Sung FC, Hsu HC, Lee YT. Hypertension
        status is the major determinant of carotid atherosclerosis: a
        community-based study in Taiwan. Stroke. 2001;32:2265-2271.

     23. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative
        Research Group. Major outcomes in high-risk hypertensive patients
        randomized to angio-tensin-converting enzyme inhibitor or calcium
        channel blocker vs diuretic. JAMA. 2002;288:2981-2997.

     24. The Heart Outcomes Prevention Evaluation Study Investigators.
        Effects of an angiotensin-converting-enzyme inhibitor. ramipril, on
        cardiovascular events in high-risk patients. N Engl J Med.
        2000;342:145-153.

     25 The Capricorn Investigators. Effect of carvedilol on outcome after
        myocardial infarction in patients with left-ventricular dysfunction: the
        CAPRICORN randomized trial. Lancet. 2001;357:1385-1390.

     26. Torng PL, Su TC, Sung FC, Chien KL, Huang SC, Chow SN, Lee YT.
        Effects of menopause on intraindividual changes in serum lipids,
        blood pressure, and body weight--the Chin-Shan Community
        Cardiovascular Cohort study. Atherosclerosis. 2002; 161:409-415.

     27. UK Prospective Diabetes Study Group. Tight blood pressure control
        and risk of macrovascular and microvascular complications in type 2
        diabetes. UKPDS 38. BMJ 1998;317:703-713.

     28. Vasan RS, Larson MG, Leip EP, et al. Assessment of frequency of
        progression to hypertension in non-hypertensive participants in The
        Framingham Heart Study. Lancet. 2001;358:1682-1686.

     29. Verdecchia P. Prognostic value of ambulatory blood pressure.
        Hypertension. 2000;35:844-851.


94
30. Whelton PK, He J, Appel LJ, et al. Primary prevention of
      hypertension: clinical and public health advisory from The National
      High Blood Pressure Education Program. JAMA. 2002;288;1882-
      1888.

31. Wang TD, Chen WJ, Chien KL, Seh-Yi Su SS, Hsu HC, Chen MF,
      Liau CS, Lee YT. Efficacy of cholesterol levels and ratios in predicting
      future coronary heart disease in a Chinese population. Am J Cardiol.
      2001;88:737-743.

32. Wing LMH, Reid CM, Ryan P, et al, for Second Australian National
      Blood Pressure Study Group. A comparison of outcomes with
      angiotensin-converting-enzyme inhibitors and diuretics for
      hypertension in the elderly. N Engl J Med. 2003;348:583-592.

33. 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.

34. Wright JT Jr. Agodoa L, Contreras G. et al. Successful blood
      pressure control in the African American Study of Kidney Disease
      and Hypertension. Arch Intern Med. 2002;162:1636-1643.

35.
                           2003




                                                                                 95
408                  503   5

            http://health91.bhp.doh.gov.tw/1-4.htm

            93    3



     GPN    1009300818

     ISBN   957-01-6950-8

96

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ACEI ARB BMI CCB CHD DASH DBP HDL-C LDL-C MAO NSAID SBP JNC7 TC TG Hypertension Guide

  • 1.
  • 2. Angiotensin converting enzyme inhibitor ACEI Angiotensin receptor blocker ARB Body mass index BMI Calcium channel blocker CCB Coronary heart disease CHD Dietary approach to stop hypertension DASH Diastolic blood pressure DBP High-density lipoprotein cholesterol HDL-C Low-density lipoprotein cholesterol LDL-C Monoamine oxidase MAO Nonsteroid anti-inflammatory drug NSAID Systolic blood pressure SBP The Seventh Report of the Joint National Committee JNC 7 on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Total cholesterol TC Triglyceride TG Aldosterone antagonist Ambulatory blood pressure monitoring Aneurysm Antecubital fossa Angioedema Angiotensin converting enzyme inhibitor (ACEI) Angiotensin receptor blocker (ARB) Autonomic dysfunction Bioavailability Body mass index (BMI) Brachial pulse -agonist -blocker Catecholamine 1
  • 3. Calcium channel blocker (CCB) Coronary heart disease (CHD) Corticotropin (ACTH) Conn's syndrome Cyclosporine Diastolic blood pressure (DBP) Dietary approach to stop hypertension (DASH) trial Doppler Dopamine Ductus arteriosus Erythropoietin (EPO) Episodic hypertension Epinephrine First dose effect Framingham study High-density lipoprotein cholesterol (HDL-C) Intrinsic sympathomimetic effect Isolated systolic hypertension Licorice Low-density lipoprotein cholesterol (LDL-C) Microalbuminuria Mineralocorticosteroid Monoamine oxidase (MAO) inhibitors Nonsteroid anti-inflammatory drug (NSAID) Norepinephrine Phase 1 Phase 5 Prehypertension Renin Systolic blood pressure (SBP) Target organ Total cholesterol (TC) Triglyceride (TG) Tyramine White-coat hypertension Withdrawal syndrome 2
  • 4. - WHO ISH Guideline,1999 7 JNC7 2003 3
  • 5. 2002 15 24.9% 18.2% 65 56.6% 40% 25% 50% 2002 59% 79% 47% 64% 21% 29% 4
  • 6. contents contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 . . . . . . . . . . . . . . . . . . . . . . .10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 . . . . . . . . . . . . . . . . . . . . . . . . .38 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 . . . . . . . . . . . . . . . . . . . . . . . . . . .74 .87 . . . . . . . . . . . . . . . . . . . . . . . . . . . .90 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91 5
  • 7. 147.7 156.8 1-1 152.9 152.3 1-1 6
  • 8. 40% 25% 50% (1) (2) (3) (4) (5) angiotensin receptor blocker (6) (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the JNC 7) (1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension & ESH Updates) 7
  • 9. (1) 120/80 mmHg 130/85 mmHg 120 139 mmHg 80 89 mmHg (2) 115/75 mmHg 20/10 mmHg (3) ( 140 mmHg) (4) DASH (5) thiazide (6) 8
  • 10. 140/90 mmHg 130/80 mmHg 20/10 mmHg thiazide (1) (2) (3) 9
  • 11. JNC 7 2003 140 mmHg / (diastolic blood pressure, DBP) 90 mmHg 120 mmHg 80 mmHg prehypertension 2-1 JNC 7 140-159 mmHg / 90-99 mmHg 160 mmHg / 100 mmHg 2-1 18 (mmHg) (mmHg) <120 <80 (prehypertension) 120-139 80-89 140-159 90-99 160 100 95 2-2 10
  • 12. 2-2 ( 90-94 ) ( 95-99 ) ( 99 ) (SBP) 7 96-105 106 8-30 104-109 110 2 SBP 104-111 112-117 118 DBP 70-73 74-81 82 3-5 SBP 108-115 116-123 124 DBP 70-75 76-83 84 6-9 SBP 114-121 122-129 130 DBP 74-77 78-85 86 10-12 SBP 122-125 126-133 134 DBP 78-81 82-89 90 13-15 SBP 130-135 136-143 144 DBP 80-85 86-91 92 16-18 SBP 136-141 142-149 150 DBP 84-91 92-97 98 Systolic blood pressure, SBP Diastolic blood pressure, DBP mmHg 11
  • 13. 210/120 mmHg 10 23 2-1 120/80 mmHg JNC 7 115/75 mmHg 20 mmHg 10 mmHg 12
  • 14. 2-1 96% JNC 7 5000 10 1993-1996 26% 19% 2002 15 24.9% 18.2% 2002 18 30 30 60 2-2 13
  • 15. 30 60 2- 3 1989-1991 65 36.9 2002 65 56.6% 40 60 2002 60 60 2-4 1990 1993-1996 46 14
  • 16. 2-2 15 2002 2-3 15 2002 2-4 15 <20 20-29 30-39 40-49 50-59 60-69 70-79 80+ 2002 15
  • 17. 140 mmHg 90 mmHg ( 120-139 mmHg 80-89 mmHg) ( ) 16
  • 18. 3-1 (cuff) 12.5 ( 3-1) (inner bag) 80% 3-1 1 2.5 1-3 5-6 4-8 9-10 12.5 14 3-1 17
  • 19. ( 2 ) (antecubital fossa) (brachial pulse)( 3-2) 20~30 mmHg 2~3 mmHg (phase 1 ) (phase 5 ) Nicolai S. Korotkoff 1905 (muffling ) 2~3 5 mmHg 18
  • 20. 3-2 21 ( 210 mmHg 120 mmHg) 3-2 3-2 18 * (mmHg) * < 120 < 80 120 - 139 80 - 89 140 - 159 90 - 99 160 - 179 100 - 109 ≥180 ≥110 * 19
  • 21. (ambulatory blood pressure monitoring) 3-3 3-3 10- 20% white-coat hypertension episodic hypertension autonomic dysfunction 135/85 mmHg 20
  • 22. 115/75 mmHg 185/115 mmHg 20 mmHg 10 mmHg 140-159 mmHg 90-99 mmHg 12 mmHg Framingham Study 50 140 mmHg isolated systolic hypertension coronary heart disease, CHD CHD CHD CHD 21
  • 23. 5 mmHg 140/90 mmHg 1999-2000 JNC 7 1993 1996 43% 53% 31% 45% 22
  • 24. 15% 22% 2002 59% 79% 47% 64% 21% 29% 23
  • 25. 96 99 5-1 24
  • 26. 1 2 3 4 1. 2. 14 25
  • 27. 5 2.5 6 2.4 3. 4. 5. 6. 26
  • 28. 5-1 1. 2. (A) (B) (C) (1) 30 g 27
  • 29. 15 mmHg 7 10 mmHg (2) (licorice) carbenoxolone ( ) (mineralocorticosteroid) (3) (corticotropin, ACTH) (4) (nonsteroid anti-inflammatory drug, NSAID) indomethacin (5) phenylpropanolamine (catecholamine) (MAO inhibitor) pargyline (tyramine) 3. 28
  • 30. 4. ductus arteriosus 5. Conn's syndrome 29
  • 31. () () () (target organ) ( 5-2) 5-2 (target organ) 50% aneurysm 1.5 mg/dL 1(+) microalbuminuria 30
  • 32. (cyclosporine) (erythropoietin, EPO) (MAO inhibitor) 31
  • 33. 1. 2. 32
  • 34. 3. 5-3 33
  • 35. 5-3 (1) (2) X (3) (catecholamine) 1. 34
  • 36. (1) Sokolow-Lyon V5 V6 R V1 S 35 (mV) (2) (3) (4) (5) 35
  • 37. (6) (7) (8) 2. 3. (1) (Doppler) 36
  • 38. (2) (renin) 24 (catecholamine) (norepinephrine) (epinephrine) (dopamine) 37
  • 39. 2003 JNC 7 6-1 6-1 * (BMI1 18.5 23.9) 10 5 20 mmHg DASH2 8 10 mmHg 2.4 g 2 8 mmHg ( 6g ) 4 9 mmHg 3 30 30cc 2 4 mmHg 15 cc(30cc 720cc 300 cc 60cc ) ) * BMI [ ( )]/[ ( )] 2 1 DASH Dietary Approach to Stop Hypertension, 2 2100 / 38
  • 40. (body mass index, BMI) BMI BMI 18.5~23.9 18.5 24 27 30 35 BMI 30 BMI BMI BMI 6-2.1 6-2.2 6-2.1 BMI ( ) BMI (Body Mass Index) 2 ( ) ( )2 22 ( 10% ) 90 80 39
  • 41. 6-2.2 (BMI) ( ) 150 41.6 41.6 54.0 54.0 60.8 67.5 78.8 151 42.2 42.2 54.7 54.7 61.6 68.4 79.8 152 42.7 42.7 55.4 55.4 62.4 69.3 80.9 153 43.3 43.3 56.2 56.2 63.2 70.2 82.0 154 43.9 43.9 56.9 56.9 64.0 71.1 83.0 155 44.4 44.4 57.7 57.7 64.9 72.1 84.1 156 45.0 45.0 58.4 58.4 65.7 73.0 85.2 157 45.6 45.6 59.2 59.2 66.6 73.9 86.3 158 46.2 46.2 59.9 59.9 67.4 74.9 87.4 159 46.8 46.8 60.7 60.7 68.3 75.8 88.5 160 47.4 47.4 61.4 61.4 69.1 76.8 89.6 161 48.0 48.0 62.2 62.2 70.0 77.8 90.7 162 48.6 48.6 63.0 63.0 70.9 78.7 91.9 163 49.2 49.2 63.8 63.8 71.7 79.7 93.0 164 49.8 49.8 64.6 64.6 72.6 80.7 94.1 165 50.4 50.4 65.3 65.3 73.5 81.7 95.3 166 51.0 51.0 66.1 66.1 74.4 82.7 96.4 40
  • 42. 167 51.6 51.6 66.9 66.9 75.3 83.7 97.6 168 52.2 52.2 67.7 67.7 76.2 84.7 98.8 169 52.8 52.8 68.5 68.5 77.1 85.7 100.0 170 53.5 53.5 69.4 69.4 78.0 86.7 101.2 171 54.1 54.1 70.2 70.2 79.0 87.7 102.3 172 54.7 54.7 71.0 71.0 79.9 88.8 103.5 173 55.4 55.4 71.8 71.8 80.8 89.8 104.8 174 56.0 56.0 72.7 72.7 81.7 90.8 106.0 175 56.7 56.7 73.5 73.5 82.7 91.9 107.2 176 57.3 57.3 74.3 74.3 83.6 92.9 108.4 177 58.0 58.0 75.2 75.2 84.6 94.0 109.7 178 58.6 58.6 76.0 76.0 85.5 95.1 110.9 179 59.3 59.3 76.9 76.9 86.5 96.1 112.1 180 59.9 59.9 77.8 77.8 87.5 97.2 113.4 181 60.6 60.6 78.6 78.6 88.5 98.3 114.7 182 61.3 61.3 79.5 79.5 89.4 99.4 115.9 183 62.0 62.0 80.4 80.4 90.4 100.5 117.2 184 62.6 62.6 81.3 81.3 91.4 101.6 118.5 185 63.3 63.3 82.1 82.1 92.4 102.7 119.8 41
  • 43. BMI 10% Dietary Approach to Stop Hypertension trial, DASH trial 1997 2 6 DASH 6-3 DASH 6-4 42
  • 44. 6-3 DASH * DASH DASH 1. / 1.6 5.2 2.0 4.4 8.2 7.5 0.1 2.0 0.4 0.7 0 0.7 1.5 0.5 0.8 0.6 0.2 0.5 5.8 2.5 4.1 0.7 2. 37 27 16 6 13 13 8 8 48 55 15 18 / 300 150 / 19 31 / 1700 4700 / 165 500 / 450 1240 / 3000 3000 * 2100 43
  • 45. 6-4 DASH 7-8 1 4-5 1 6 oz 4-5 6 oz 1 1/4 2-3 8 oz 1 1% 1.5 oz 2 3 oz 1-2 1.5 oz 1/3 2 DASH 44
  • 46. 10 mmHg 6-5 6-6 6-7 6-8 6-5 100 100 ( )( ) ( )( ) 111 2.8 256 6.6 135 3.5 270 6.9 142 3.6 274 7.0 151 3.9 279 7.2 154 3.9 293 7.5 166 4.2 322 8.2 196 5.0 326 8.4 203 5.2 349 8.9 221 5.7 350 9.0 221 5.7 398 10.2 222 5.7 416 10.7 228 5.8 420 10.8 234 6.0 461 11.8 235 6.0 469 12.0 238 6.0 546 14.0 245 6.3 () 1482 38.0 A 254 6.5 193 4.9 65 1.5 207 5.3 () 102 2.6 214 5.5 111 2.8 221 5.7 () 112 2.9 245 6.3 125 3.2 291 7.5 130 3.3 315 8.1 135 3.5 323 8.3 167 4.3 401 10.3 170 4.4 495 12.7 176 4.5 536 13.7 181 4.6 45
  • 47. 6-6 ( /100 ) 50 100 101 200 () 201 300 301 400 400 () 6-7 ( ) 599 250 445 238 ( ) 444 231 434 230 418 219 379 189 46
  • 48. 318 177 294 169 283 () 163 281 162 280 153 250 6-8 /100 100.0 32.5 45.4 17.6 100.0 39.6 44.3 11.8 100.0 48.2 42.3 4.2 100.0 86.0 6.0 2.0 100.0 47.9 38.4 9.3 100.0 17.0 47.0 31.0 100.0 15.2 40.0 40.5 100.0 15.0 23.1 57.6 100.0 12.7 24.7 58.2 100.0 10.2 20.9 63.8 100.0 9.4 12.5 73.8 80.0 49.3 23.1 3.0 47
  • 49. 11 mmHg JNC 7 2.4 6 6-9 48
  • 50. 6-10 6-11 6-1 6-9 ( )/ 100 ( 100 ) 100 6-10 1. 49
  • 51. 2. 3. 1. 2. 3. 1. 2. 3. 50
  • 52. 1. 2. 6-11 1 2 2000 5 1 1 1/5 6 1/5 1 3 1 5 2 1/2 12 2 10 2/5 2 51
  • 53. 6-1 220 / 60 80% 10 mmHg JNC 7 30 52
  • 54. 210 0.6 g/kg 30 cc 30 cc 720 cc 300 cc 200 cc 60 cc 60 cc 30 cc 6-12 6-12 30 cc cc. 30 cc (cc.) 16.50% 180 15% 200 15% 200 10.50% 290 34% 90 28.50% 100 35% 90 54% 60 19.50% 150 4.50% 670 53
  • 56. 55
  • 57. JNC 7 140/90 mmHg 140/90 mmHg 130/80 mmHg 7-1 56
  • 58. 7-1 (<140/90 mmHg <130/80mmHg ( ( 160 mmHg 140-159 mmHg (ACEI, 90-99 mmHg) ARB, diuretics, - thiazide blockers, CCB thiazide ACEI ARB - ACEI, ARB, -blockers, blockers, CCB CCB 140-159 mmHg 90~99 mmHg 57
  • 59. 160 mmHg 100 mmHg angiotensin converting enzyme inhibitor, ACEI angiotensin receptor blocker, ARB -blocker calcium channel blocker, CCB thiazide 7-1 7-2 7-3 7-1 Class- Drug (Trade Name)- ( ) Usual Dose Range Daily mg/d- Frequency- Thiazide diuretics Chlorothiazide (Diuril) 125-500 1 Chlorthalidone (generic) 12.5-25 1 Hydrochlorothiazide(Microzide, 12.5-50 1 HydroDIURIL)+ Polythiazide(Renese) 2-4 1 Indapamide(Lozol, Natrilix)+ 1.25-2.5 1 Metolazone(Mykrox) 0.5-1.0 1 Metolazone(Zaroxolyn) 2.5-5 1 Loop diuretics Bumetanide(Bumex, Burinex)+ 0.5-2 2 Furosemide(Lasix)+ 20-80 2 Torsemide(Demadex)+ 2.5-10 1 58
  • 60. Potassium- Amiloride(Midamor)+ 5-10 1-2 sparing diuretics Triamterene(Dyrenium) 50-100 1-2 Aldosterone- Eplerenone(Inspra) 50-100 1-2 receptor blockers Spironolactone(Aldactone)+ 25-50 1-2 -Blockers Atenolol(Tenormin)+ 25-100 1 Betaxolol(Kerlone)+ 5-20 1 Bisoprolol(Zebeta)+ 2.5-10 1 Metoprolol(Lopressor, Betaloc)+ 50-100 1-2 Metoprolol extended release 50-100 1 (Toprol XL) Nadolol(Corgard)+ 40-120 1 Propranolol(inderal)+ 40-160 2 Propranolol long-acting(InderalLA)+ 60-180 1 Timolol(Blocadren)+ 20-40 2 -Blockers with Acebutolol(Sectral)+ 200-800 2 intrinsic sympathomimetic activity Penbutolol(Levatol) 10-40 1 Pindolol(generic) 10-40 2 Combined Carvedilol(Coreg, Dilatrend) 12.5-50 2 -and -blockers Labetalol(Normodyne, Trandate)+ 200-800 2 59
  • 61. ACE inhibitors Benazepril(Lotensin)+ 10-40 1-2 Captopril(Capoten)+ 25-100 2 Enalapril(Vasotec, Renitec)+ 2.5-40 1-2 Fosinopril(Monopril) 10-40 1 Lisinopril(Prinivil, Zestril)+ 10-40 1 Moexipril(Univasc) 7.5-30 1 Perindopril(Aceon) 4-8 1-2 Quinapril(Accupril) 10-40 1 Ramipril(Altace, Tritace) 2.5-20 1 Trandolapril(Mavik) 1-4 1 Angiotensin P Candesartan(Atacand Blopress) 8-32 1 receptor blocker Eprosartan(Tevetan) 400-800 1-2 Irbesartan(Aprovel) 150-300 1 Losartan(Cozaar) 25-100 1-2 Olmesartan(Benicar) 20-40 1 Telmisartan(Micardis) 20-80 1 Valsartan(Diovan) 80-320 1 Calcium channel Diltiazem extened release( 180-420 1 blockers- Cardizem CD, Dilacor XR, non- Tiazact)+ dihydropyridines Diltiazem extended release( 120-540 1 Cardizem LA) Verapamil immediate release( 80-320 2 Calan, Isoptin)+ Verapamil long-acting(Calan 120-360 1-2 SR, Isoptin SR)+ Verapamil-coer(Covera HS, 120-360 1 Verelan PM) 60
  • 62. Calcium channel Amlodipine(Norvasc) 2.5-10 1 blockers- Felodipine(Plendil) 2.5-20 1 dihydropyridines Isradipine(Dynacirc CR) 2.5-10 2 Nicardipine sustained release 60-120 2 (Cardene SR) Nifedipine long-acting (Adalat 30-60 1 CC, Procardia XL) Nisoldipine(Sular) 10-40 1 -Blockers Doxazosin(Cardura, Doxaben) 1-16 1 Prazosin(Minipress) 2-20 2-3 Terazosin(Hytrin) 1-20 1-2 Central - Clonidine(Catapres) 0.1-0.8 2 2 agonists and Clonidine patch(Catapres TTS) 0.1-0.3 1 weekly other centrally acting drugs Methyldopa(Aldomet) 250-1000 2 Reserpine(generic) 0.05-0.25 1# Guanfacine(generic) 0.5-2 1 Direct Hydralazine(Apresoline)+ 25-100 2 vasodilators Minoxidil(Loniten)+ 2.5-80 1-2 Abbreviation: ACE, angiotensin-converting enzyme. * Dosages may vary from those listed in the Physicians Desk Reference. Which may be consulted for additional information. Are now or will soon become available in generic preparations. + A 0-1 mg dose may be given every other day to achieve this dosage. # 61
  • 63. 7-2 Thiazides Loop diuretics thiazides Potassium- ACE NSAID sparing agents Spironolactone Triamterene Amiloride ( ) Acebutolol Atenolol Betaxolol Bisoprolol Carteolol HDL (pindolol Metoprolol acetbutolol ) Pindolol Propranolol Timolol ( -1- ) Prazosin (first doseeffect) Terazosin 62
  • 64. ( ) Labetalol Vasodilators Hydralazine Antinuclear antibody(ANA) Minoxidil Captopril Cilazapril Enalapril Fosinopril Lisinopril Quinapril Candesartan Eprosartan Irbesartan 63
  • 65. Losartan ( ) Olmesartan ( ) Telmisartan Valsartan ( ) Verapamil Diltiazem Nifedipine Nicardipine Felodipine Amlodipine Isradipine Clonidine - Methyldopa clonidine catecholamine Guanabenz Guanfacine 64
  • 66. Guanadrel sulfate Guanethidine monosulfate Rauwolfia alkaloids Reserpine 7-3 Cholestyramine colestipol Aldosterone thiazides furosemide NSAID( aspirin ) NSAID - Cimetidine diltiazem verapamil Rifampin phenobarbital Quinidine reserpine 65
  • 67. theophylline lidocaine chlorpro-mazine ( phenylpropanolamine ephedrine pseudoephedrine ) epine-phrine ( receptor ) - ( ) ACE NSAID( aspirin ) ACE NSAID ( ) ACE (bioavailability) 66
  • 68. NSAID( aspirin ) ( NSAID ) Cimetidine Verapamil digoxin carbamazepine rifampin verapamil diltiazem carbamazepine diltiazem verapamil phenobarbital Verapamil phenytoin verapamil prazosin theophylline Cyclosporine guanethidine ephedrine amphetamine clonidine Methyldopa phenothiazine Monoamine oxidase inhibitors (MAO ) tyramine 67
  • 69. norepinephrine reserpine guanethidine clonidine guanabenz thiazide thiazide () thiazide Treatment to Prevent Heart Attack trial Anti-Hypertension and Lipid-lowering trial thiazide The Second Australian National Blood Pressure trial ACE 68
  • 70. thiazide thiazide ACEI ARB -blocker CCB () 7-4 7-4 ACE 69
  • 71. () 20/10 mmHg 7-5 7-5 Combination Type Fixed-Dose Combination, mg* Trade Name ACE inhibitors and Amlodipine/benazepril hydrochloride(2.5/10,5/10,5 Lotrel CCBs /20,10/20) Enalapril maleate/felodipine (5/5) Lexxel Trandolapril/verapamil (2/180,1/240,2/240,4/240) Tarka ACE inhibitors and Benazepril/hydrochlorothiazide (5/6.25,10/12.5,50/ Lotensin HCT diuretics 15,50/25) Captopril/hydrochlorothiazide (25/15,25/25,50/15, Capozide 50/25) Enalapril maleate/hydrochlorothiazide (5/12.5,10/25) Vaseretic Lisinopril/hydrochlorothiazide (5/12.5,20/12.5,20/25) Prinzide Moexipril HCI/hydrochlorothiazide (7.5/12.5,15/25) Uniretic Quinapril HCI/hydrochlorothiazide (10/12.5,20/12.5, Accuretic 20/25) ARBs and diuretics Candesartan cilexetil/hydrochlorothiazide (16/12.5,32 Atacand HCT /12.5) Eposartan cilexetil/hydrochlorothiazide (600/12.5,600 Teveten HCT 70
  • 72. /25) Irbesartan/hydrochlorothiazide (75/12.5,150/12.5,300 Avalide /12.5) Losartan potassium/hydrochlorothiazide (50/12.5,100 Hyzaar /25) Telmisartan/hydrochlorothiazide (40/12.5,80/12.5) Micardis HCT Valsartan/hydrochlorothiazide (80/12.5,160/12.5) Diovan HCT -Blockers and Atenolol/chlorthalidone (50/25,100/25) Tenoreic diuretics Bisoprolol fumarate/hydrochlorothiazide (2.5/6.25,5/ Ziac 6.2510/6.25) Propranolol tartrate/hydrochlorothiazide (40/25,80/25) Inderide Metoprolol tartrate/hydrochlorothiazide (50/25,100/25) Lopressor HCT Nadolol/bendrofluthiazide (40/5,80/5) Cozide Timolol maleate/hydrochlorothiazide (10/25) Timolide Centrally acting Amiloride HCI/hydrochlorothiazide (250/15,250/25, Aldoril grug and diuretic 500/30,500/50) Reserpine/chlorothiazide (0.125/250,0.25/500) Diupres Reserpine/hydrochlothiazide Hydropres Diuretic and diuretic Amiloride HCI/hydrochlorothiazide (5/50) Moduretic Spironolactone/hydrochlorothiazide (25/25,50/50) Aldactone Triamterene/hydrochlorothiazide (37.5/25,50/25,75 Dyazide. /50) Maxzide Abbreviations:ACE angiotensin-converting enzyme:ARB, angiotensin-receptor blocker,CCB,calcium channel blocker,HCI,hydrochloride,HCT,hydrochlorothiazide,LA, long- acting. * Some drug combinations are available in multiple fixed doses. Each drug dose is reported in milligrams. 71
  • 73. () (serum potassium K) (creatinine Cr) Aspirin 7-6 72
  • 74. 7-6 (1) (2) a. b. c. d. NSAID (3) (4) (5) 30 cc 73
  • 75. 140 mmHg 90 mmHg guanethidine guanadrel -1 labetalol 95 (Doppler) 74
  • 76. ACE 2 3 75
  • 77. (1) (2) (3) (4) 140/90 mmHg 30 mmHg 15 mmHg 140/90 mmHg 6 mg/dL 1. ACE methyldopa ACE 2. 76
  • 78. 100 mmHg methyldopa hydralazine - - hydralazine furosemide nifedipine clonidine 77
  • 79. >220 mmHg >120 mmHg 220 mmHg 120 mmHg 10 15% ACE thiazide ACE ACE 78
  • 80. ACE loop ACE hydralazine minoxidil 79
  • 81. ACE ACE 130/80 mmHg -1 / ACE - - phenylpropanolamine guanethidine reserpine 80
  • 82. - agonist total cholesterol , TC high-density lipoprotein cholesterol, HDL-C low-density lipoprotein cholesterol, LDL-C triglyceride, TG 8- 1 Thiazide loop LDL-C HDL-C intrinsic sympathomimetic effect labetalol -1- LDL-C ACE 81
  • 83. 8-1 2 TC/HDL-C =( 5 HDL-C ) 40 mg/dL X V 200 mg/dL 200 mg/dL TC 240 mg/dL X X 240 mg/dL V X 130 mg/dL 130 mg/dL LDL- C 160 mg/dL X X 160 mg/dL TG 200 mg/dL ( 200 ( X V mg/dL TC/HDL-C 5 (87/4/1) HDL-C 40 ) mg/dL) 160 X X TC 200 mg/dL mg/dL (87/7/1) 100 LDL-C 130 X X mg/dL mg/dL (87/7/1) TG 200 mg/dL 150 ( X V mg/dL TC/HDL-C 5 (87/7/1) HDL-C 40 mg/dL) 1000 mg/dL (87/4/1) 1. (1) (2) (3) 2. (1) (2) (3) 70% 3. 1. 2. 3. 45 4. 5. 55 6. 82
  • 84. Thiazide ( :allopurinol) ( probenecid) thiazide (1) 60 ml/min/1.73 m2 ( 1.5 mg/dL 1.3 mg/dL) (2) 300 mg 200 mg/gm 130/80 mmHg ACE 35 ACE 30 ml/min/1.73 m2 ( 2.5 3.0 mg/dL) loop 83
  • 85. ( 30) ( 90 80 BMI 24) ( 110 mg/dL) 130/85 mmHg ( 150 mg/dL) ( 40 mg/dL 50 mg/dL) 10 mmHg ( - ) (norepinephrine) 84
  • 86. - ( phentolamine) ( ) (Cyclosporine) 50 70 labetalol clonidine diltiazem nicardipine verapamil 85
  • 87. ( 7-2) Thiazide ( ) Raynaud - Thiazide ACE ACE (angioedema) 5 mEq/L 86
  • 88. ( ) ( 120-139 mmHg 80-89 mmHg) JNC 7 5 mmHg 14% 9% 7% (1) (2) (3) ( ) (4) 87
  • 89. (5) (6) (1) ( ) ( ) 88
  • 90. (2) ( ) ( ) ( ) 89
  • 91. 90
  • 92. 1. American Diabetes Association. Treatment of hypertension in adults with diabetes. Diabetes Care. 2003;26(suppl 1):S80-S82. 2. Black HR, Elliott WJ, Grandits G, et al. Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. JAMA. 2003;289:2073-2082. 3. Blood Pressure Lowering Treatment Trialists Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure- lowering drugs: results of prospectively designed overviews of randomized trials. Lancet. 2000;256:1955-1964. 4. Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861-869. 5. Chien KL, Sung FC, Hsu HC, Su TC, Lee YT. Left ventricular mass and correlated atherosclerotic risk factors in young adolescents: report from Chin-Shan community cardiovascular study in Taiwan. Atherosclerosis. 2001;155:431-437. 6. Chobanian AV, Bakris GL, Black HR, et al. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-1252. 7. Chobanian AV, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, 91
  • 93. Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-2572. 8. Dahlof B, Devereux RB, Kjeldsen SE. et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE). Lancet. 2002;359:995-1003. 9. Guidelines Subcommittee: 1999 World Health Organization- International Society of Hypertension guidelines for the management of hypertension. J Hypertens. 1999;17:151-183. 10. Guidelines Committee. 2003 European Society of Hypertension- European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21:1011-1053. 11. Kjeldsen SE, Erdine S, Farsang C, Sleight P, Mancia G; 1999 WHO/ISH Hypertension Guidelines subcommittee. 1999 WHO/ISH Hypertension Guidelines--highlights & ESH update. J Hypertens. 2002;20:153-155. 12. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortaility. Lancet. 2002;360:1903-1913. 13. Lee YT, Lin RS, Sung FC, Yang CY, Chien KL, Chen WJ, Su TC, Hsu HC, Huang YC. Chin-Shan Community Cardiovascular Cohort in Taiwan-baseline data and five-year follow-up morbidity and mortality. J Clin Epidemiol. 2000;53:838-846. 14. Lewis WJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with 92
  • 94. nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851- 860. 15. National Kidney Foundation Guideline. K/DOQI clinical practice guidelines for chronic kidney disease: kidney Disease Outcome Quality Initiative. Am J Kidney Dis. 2002;39(suppl 2):S1-S246. 16. National Cholesterol Education Program. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143-3421. 17. National High Blood Pressure Education Program. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183:S1-S22. 18. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Update on the 1987 Task Force Report on high blood pressure in children and adolescents. Pediatrics. 1996;98:649-658. 19. Pan WH, Chang HY, Yeh WT, Hsiao SY, Hung YT. Prevalence, awareness, treatment and control of hypertension in Taiwan: results of Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996. J Hum Hypertens. 2001;15:793-798. 20. Pitt B, Remme W, Zannad F. et al. Eplerenone a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309-1321. 21. Sacks FM, Svetkey LP, Vollmer WM, et al, for the DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension 93
  • 95. (DASH) diet. N Engl J Med. 2001;344;3-10. 22. Su TC, Jeng JS, Chien KL, Sung FC, Hsu HC, Lee YT. Hypertension status is the major determinant of carotid atherosclerosis: a community-based study in Taiwan. Stroke. 2001;32:2265-2271. 23. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angio-tensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA. 2002;288:2981-2997. 24. The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor. ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145-153. 25 The Capricorn Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomized trial. Lancet. 2001;357:1385-1390. 26. Torng PL, Su TC, Sung FC, Chien KL, Huang SC, Chow SN, Lee YT. Effects of menopause on intraindividual changes in serum lipids, blood pressure, and body weight--the Chin-Shan Community Cardiovascular Cohort study. Atherosclerosis. 2002; 161:409-415. 27. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. BMJ 1998;317:703-713. 28. Vasan RS, Larson MG, Leip EP, et al. Assessment of frequency of progression to hypertension in non-hypertensive participants in The Framingham Heart Study. Lancet. 2001;358:1682-1686. 29. Verdecchia P. Prognostic value of ambulatory blood pressure. Hypertension. 2000;35:844-851. 94
  • 96. 30. Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288;1882- 1888. 31. Wang TD, Chen WJ, Chien KL, Seh-Yi Su SS, Hsu HC, Chen MF, Liau CS, Lee YT. Efficacy of cholesterol levels and ratios in predicting future coronary heart disease in a Chinese population. Am J Cardiol. 2001;88:737-743. 32. Wing LMH, Reid CM, Ryan P, et al, for Second Australian National Blood Pressure Study Group. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med. 2003;348:583-592. 33. 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. 34. Wright JT Jr. Agodoa L, Contreras G. et al. Successful blood pressure control in the African American Study of Kidney Disease and Hypertension. Arch Intern Med. 2002;162:1636-1643. 35. 2003 95
  • 97. 408 503 5 http://health91.bhp.doh.gov.tw/1-4.htm 93 3 GPN 1009300818 ISBN 957-01-6950-8 96