Changes in Blood Pressure Classification JNC 6 and

Changes in Blood Pressure Classification (JNC 6 and 7) JNC 6 category SBP/DBP JNC 7 category Optimal Normal Borderline Hypertension Stage 1 Stage 2 Stage 3 Normal Prehypertension <120/80 120 -129/80 -84 130 -139 or 85 -89 ≥ 140/90 140 -159 or 90 -99 160 -179 or 100 -109 ≥ 180/110 Hypertension Stage 1 Stage 2

고혈압 환자의 평가 분류 세부내역 기본검사 키, 몸무게, BMI(kg/m 2) 혈액검사 : FBS, Lipid profile(TC, HDL, TG)-fasting, uric acid, Cr, K, Calcium, Hb, Hct Urinalysis : Proteinuria, glycosuria, deposit EKG, Chest X-ray 보충검사 Echo, Carotid Doppler(IMT), CRP, microalbuminuria(DM에서 필수) 24 urine protein collection(dipstick에서 단백뇨 양성인 경우) Fundoscopy( 중증고혈압), 24시간 활동혈압 확대검사 합병증이 있는 경우 뇌, 심장, 신장기능 검사

Clinical Trial and Guideline Basis for Compelling Indications for individual Drug Classes JAMA 2003; 289: 2560 -2572

VALIANT (Valsartan in Acute Myocardial Infarction Trial) NEJM 2003; 349: 1893 -906

CHARM(Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity) alternative trial Lancet 2003; 362: 772 -776

OPTIMAAL(Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Lorsartan) Lancet 2002; 360: 752 -60

Algorithm for Treatment of Hypertension Lifestyle Modification Not at Goal BP (<140/90 m. Hg or <130/80 mm. Hg for Those with Diabetes Or Chronic Kidney Disease) Initial Drug Choices Hypertension Without Compelling Indications Stage 1 Hypertension (SBP 140 -159 mm. Hg or DBP 90 -99 mm. Hg) Thiazide-Type Diuretics for Most May Consider ACEI, ARB, β-blocker, CCB, or combination Stage 2 Hypertension (SBP≥ 160 mm. Hg or DBP≥ 100 mm. Hg) 2 -Drug Combination for Most (usually Thiazide-Type Diuretic And ACEI or ARB or β-blocker, CCB) Hypertension With Compelling Indications Drug(s) for the Compelling indications Other Antihypertensive Drugs (Diuretics, ACEI, ARB, β-blocker, CCB) as Needed Not at Goal BP Optimize Dosages or Additional Drugs Until Goal BP is Achieved Consider Consultation With Hypertension Specialist

ACE 억제제 성분명 상품명 제제 1회용량/횟수 Alacepril Cetapril 25, 50 mg 25 -75 mg/1 -2회 Benazepril Cibacen 5, 10, 20 mg 5 -20 mg/1회 Captopril Capoten 12. 5, 25, 50 mg 25 -100 mg/1 -2회 Cilazapril Inhibace 0. 5, 1, 2. 5 mg 1. 25 -5 mg/1회 Delapril Kedapril 15 mg 7. 5 -60 mg/1회 Enalapril Renitec 5, 10 mg 5 -40 gmg/1회 Fosinopril Monopril 10, 20 mg 10 -40 mg/1회 Imidapril Tanatril 5, 10 mg 2. 5 -10 mg/1회 Lisinopril Zestril 10 mg 10 -20 mg/1회 Moexipril Univasc 7. 5, 15 mg 7. 5 -15 mg/1회 Perindopril Acertil 4 mg 4 -8 mg/1회 Quinapril Accupril 10 mg 10 -20 mg/1 -2회 Ramipril Tritace 2. 5, 5 mg 2. 5 -10 mg/1회 Temocapril Acecol 1, 2, 4 mg 1 -4 mg/1회

ARB 성분명 상품명 경구생체 신장배설 이용율 (%) 반감기 (시간) 제제 용량(mg/d)/ 횟수 Candesartan Atacand 42 13 8 8, 16 mg 8 -32/1회 Eprosartan Teveten 13 7 5 -7 600 mg 600 -800/1회 Irbesartan Aprovel 70 20 11 -15 150, 300 mg 150 -300/1회 Losartan Cozaar 33 50 6 -9 50, 100 mg 25 -100/1회 Olmesartan Olmetec 20 mg 10 -40/1회 Telmisartan Pritor 42 Micardis <1 24 40, 80 mg 20 -80/1회 Valsartan Diovan 10 -15 5 -9 40, 80, 160 mg 80 -320/1회 23

Beta Blockers 분류 성분명 상품명 제제 1회용량/횟수 심장선택적 Atenolol Tenormin 25, 50 mg 25 -100 mg/1회 Betaxolol Kerlone 10, 20 mg 10 -20 mg/1회 Bevantolol Calvan 50, 100 mg 100 -200 mg/1회 Bisoprolol Concor 2. 5, 5 mg 5 -10 mg/1회 Celiprolol Selectol 200 mg 200 -400 mg/1회 Acebutolol* Sectral 200, 400 mg 200 -400 mg/1 -2회 Metoprolol Betaloc 100 mg 50 -200 mg/1 -2회 Nadolol* Corgard 40 mg 40 -240 mg/1회 Propranolol Pranol 10, 40 mg 40 -240 mg/1 -2회 Carteolol Mikelan 5 mg 2. 5 -10 mg/2 -3회 Penbutolol* Betapressin 40 mg 10 -40 mg/1 -2회 Pindolol* Visken 5 mg 5 -10 mg/1 -3회 Arotinolol Almarl 5, 10 mg 5 -15 mg/1 -2회 Carvedilol Dilatrend 6. 25, 12. 5, 25 mg 6. 25 -25 mg/1 -2회 Labetalol Trandate 100 mg 200 -600 mg/2회 심장비선택적 알파베타차단제 * 생산중지

CCB 성분명 상품명 제제 1회용량/횟수 Amlodipine Norvasc 5, 10 mg 2. 5 -10 mg/1회 Barnidipine Oldeca 5, 10, 15 mg 5 -15 mg/1회 Benidipine Coniel 4, 8 mg 2 -8 mg/1회 Cilnidipine Cinalong 5, 10 mg 5 -20 mg/1회 Efonidipine Finte 20, 40 mg 20 -40 mg/1회 Felodipine Munoval Splendil 2. 5, 5 mg 2. 5 -10 mg/1회 Isradipine Dyna. Circ 2. 5, 5 mg 2. 5 -10 mg/1회 Lacidipine Vaxar 2, 4 mg 2 -4 mg/1회 Lercanidipine Zanidip 10 mg 5 -20 mg/1회 Manidipine Madipine 10, 20 mg 5 -20 mg/1회 Nicardipine Perdipine-SR 40 mg 20 -40 mg/2회 Nifedipine Adalat-Oros 30, 60 mg 30 -60 mg/1회 Nivadipine Nivaldil 2, 4 mg 2 -4 mg/1회 Nisoldipine Nisoldin 5, 10 mg 5 -10 mg/1회 Nitrendipine Baypress 10, 20 mg 10 -40 mg/1회 Diltiazem Herben/Dilteran 90, 180 mg 90 -180 mg/1회 Verapamil Isoptin 40 -480 mg/1회 40, 80, 180, 240 mg

Diuretics 분류 성분명(상품명) 제제 1회용량/횟수 Thiazide계 Hydrochlorothiazide (Dichlozid) 25 mg 12. 5 -25 mg/1회 Chlorthalidone (Chlorthalidon) 25 mg 6. 25 -25 mg/1회 Indapamide (Fludex, Natrix) 1, 1. 5, 2. 5 mg 1. 5 -2 mg/1회 Metolazone (Zaroxolyn) 5, 10 mg 2. 5 -5 mg/1회 Tripamide (Tripamol) 15 mg 7. 5 -15 mg/1 -2회 Furosemide (Lasix) 40 mg 20 -40 mg/2 -3회 Torasemide (Torem) 2. 5, 5, 10 mg 2. 5 -5 mg/1회 Spironolactone (Aldactone) 25, 50 mg 25 -50 mg/1 -2회 Amiloride(Amilo) 5 mg 2. 5 -5 mg/1회 Loop계 K-sparing

Alpha-blocker 성분명 상품명 제제 1회용량/횟수 Bunazosin Detantol* 1 mg 1 -6 mg/2 -3회 Doxazosin Cardura-XL 4 mg 4 -8 mg/1회 Prazosin Minipress* 1, 2 mg 0. 5 -6 mg/2 -3회 Terazosin Hytrine 1, 2, 5 mg 1 -10 mg/1회 * 생산중지

이상적인 병합요법의 예 Alpha-blocker Beta-blocker 추천되는 병합 Diuretics ACE inhibitors Calcium antagonists AT receptor blockers

국내생산 병합약제 상품명 성분명 및 제제 Aldactazide 25, 50 Aldactone + hydrochlorothiazide 25/25, 50/50 mg Betazide Metoprolol tartrate + hydrochlorothiazide 100/12. 5 mg Atacand-plus Candesartan + hydrochlorothiazide 16/12. 5 mg Capozide* Captopril + hydrochlorothiazide 50/25 mg Co-Aprovel Irbesartan + hydrochlorothiazide 150/12. 5, 300/12. 5 mg Co-Diovan Valsartan + hydrochlorothiazide 80/12. 5, 160/12. 5 mg Cozaar-plus Losartan + hydrochlorothiazide 50/12. 5, 100/25 mg Minizide* Minipress + polythiazide 0. 5/0. 25 mg Logimax Felodipine + metoprolol succinate 5/47. 5 mg Sectrazide* Acebutolol + hydrochlorothiazide 400/25 mg Micardis-plus Pritor-plus Telmisartan + hydrochlorothiazide 40/12. 5, 80/12. 5 mg Univasc-plus Moexipril + hydrochlorothazide 7. 5/12. 5, 15/25 mg Tritace-plus Ramipril + hydrochlorothiazide 2. 5/12. 5, 5/25 mg Tenoretic Atenolol + chlorthalidone 50/12. 5 mg * 생산중지

2차성 고혈압의 검사 의심되는 질환 진단검사 만성 신질환 Estimated GFR 대동맥축착증 CT angiography 쿠싱증후군과 만성 스테로이드 치료에 History/dexamethasone supression 따른 당질 코르티코이드 과잉상태 test 약제유발성 History; drug screening 갈색세포종 24시간 소변: VMA, Metanephrine 일차성 알도스테론증과 기타 전해질 부신 피질 호르몬 과잉상태 Renin, aldosterone level or specific measurement of other mineralocorticoids 신혈관성 고혈압 Doppler flow study: MR angiography(Renal CT angiography) 수면무호흡 Sleep study with O 2 saturation 갑상선 혹은 부갑상선질환 TFT; serum PTH

Lancet 2002; 360: 1903 -13