1 Essential Hypertension Primary hypertension 2 Secondary Hypertension

고혈압의 종류 1. 본태성 고혈압 (Essential Hypertension) Primary hypertension 2. 이차성 고혈압 (Secondary Hypertension) – Sleep apnea – Drug-induced or related causes – Chronic kidney disease – Primary aldosteronism – Renovascular disease – Chronic steroid Tx and Cushing’s syndrome – Pheochromocytoma – Coarctation of the aorta – Thyroid or parathyroid disease

한국인 고혈압 유병률 1998 Age (year) 2001 Men Women 20 -29 15. 6 3. 1 10. 8 1. 7 30 -39 18. 4 6. 1 17. 5 5. 4 40 -49 29. 6 18. 1 28. 9 15. 9 50 -59 40. 2 34. 5 40. 0 33. 3 60 -69 42. 4 46. 5 57. 0 57. 9 70 - 46. 9 60. 4 52. 6 61. 3 Total 22. 5 16. 9 24. 8 19. 4 대한 고혈압학회지 May 2003

성인의 혈압분류 및 치료 BP Classificatio n Normal Initial Drug Therapy SBP mm. Hg DBP mm. Hg Lifestyle Modification < 120 and < 80 Encourage Without Compelling Indication With Compelling Indication Drugs for compelling Indication No drug Tx Pre-HTN Stage 1 Stage 2 120 -139 140 -159 >160 or 80 -89 or 90 -99 or >100 Yes Thiazide-type diuretics ACEI, ARB, BB, CCB or combination Yes 2 drugs comb (thiazides + ACEI / ARB / BB / CCB) Drugs for compelling Indication. Anti-HTN (diuretics, ACEI, ARB, BB, CCB) as needed. Based on the JNC 7

Cardiovascular Risk Factors • Hypertension • Smokingng • Obesity (body mass index >30 kg/m 2 • Physical inactivity • Dyslipidemia • Diabetes mellitus • Microalbuminuria or estimated GFR <60 ml. min • Age ( older than 55 for men, 65 for wemen) • Family History of premature CVD (men under age 55 or women under age 65) Based on the JNC 7

표적장기 손상 Target Organ Damage(TOD) • Heart disease – Left ventricular hypertrophy – Angina or prior MI – Prior coronary revascularization – Heart Failure • Brain : Stroke or TIA • Chronic kidney disease • Peripheral arterial disease • Retinopathy Based on the JNC 7

동반질환별 약물선택 Compelling Indication Diuretics BB ACEI ARB Heart Failure O O Post MI O O O High Coronary Dis. risk O O O Diabetes O O O Chronic kidney disease Recurrent stroke prevention O CCB O O O Based on the JNC 7

작용기전 및 영향 기침 Angiotensin I Bradykinin ACEI Inactive fragments Angiotensin II AT 1 Receptor 혈관수축 식염, 수분 저류 교감신경 활성화 혈관, 간질 조직 증식 Alternative pathway AT 2 Receptor 혈관확장 세포증식억제

작용기전 및 영향 기침 Angiotensin I Bradykinin ACEI Inactive fragments Angiotensin II Alternative pathway ARB AT 1 Receptor 혈관수축 식염, 수분 저류 교감신경 활성화 혈관, 간질 조직 증식 AT 2 Receptor 혈관확장 세포증식억제

주요 ACE 억제제 • Fosinopril (Monopril) • Ramipril (Tritace) • Cilazapril (Inhibace) • Perindopril (Acertil) • Lisinopril (Zestril) • Quinapril (Accupril) • Moexipril (Univasc) • Imidaril (Tanatril)

ATI receptor blocker • Losartan(Cozaar) • Candesartan(Atacand) • Irbesartan(Aprovel) • Valsartan(Diovan) • Telmisartan(Micardis) • Eprosartan(Tevetan)