Avtor/Urednik		Dobovišek, Jurij
Naslov		Nadzor hipertenzije po smernicah: kdaj zdravila, izbira, prilagoditev bolniku
Tip		članek
Vir		Slov Kardiol
Vol. in št.		Letnik 1, št. 2
Leto izdaje		2004
Obseg		str. 46-9
Jezik		slo
Abstrakt		The primary goal of treatment of the hypertensive patient is to achieve the maximum reduction in long-term total risk of cardiovascular and renal morbidity and mortality. This requires treatment of all the reversible risk factors identified, and the appropriate management of target organ damage and associated clinical conditions, as well as proper control of the raised blood pressure per se. All recent guidelines recommend the lowering of blood pressure at least below 140/90 mm Hg, and to definite lower values, if tolerated, in all hypertensive patients, and below 130/80 mm Hg in diabetics or patients with renal disease. When in next ten years added risk for major cardiovascular events or cardiovascular death reaches or exceeds 20% or 5% respectively, the introduction of antihypertensive agents into treatment of hypertension is strongly suggested. When no compelling indication is present, the major classes of antihypertensive agents - diuretics, betablockers, calcium channel antagonists, ACE inhibitors, and angiotensin receptor blockers are suitable for the initiation and maintenance of the therapy of essential hypertension. As the alternative to initial monotherapy a low-dose combination of two agents is recommended. The choice of drug therapy should be adapted to individual patient considering other risk factors, arised target organ damage, associated clinical conditions, other diseases, drugs taken for other reasons, probable patogenetic mechanism of patient's hypertension, and the cost of drugs. A different approach is recommended in secondary forms of hypertension and in compelling indications.
Izvleček		Zadnje evropske in slovenske smernice za obravnavo bolnikov z arterijsko hipertenzijo priporočajo pri esencialni hipertenziji uvajanje antihipertenzijskih zdravil, kadar je dodatno tveganje za pojav večjih srčnožilnih zapletov ali umrljivost zaradi njih v naslednjih 10 letih ocenjeno kot veliko ali zelo veliko po metodologiji Framinghamske raziskave ali projekta SCORE. Pri manjšem tveganju smernice priporočajo do največ 12 mesecev poizkušati krvni tlak znižati najprej z izboljšanjem življenjskih navad. Kot prvo izbiro priporočajo bolniku prilagojeno monoterapijo z diuretikom ali blokatorjem receptorjev beta ali kalcijevim antagonistom ali zaviralcem angiotenzinske konvertaze ali blokatorjem receptorjev angiotenzina. Druga možnost je pravilna kombinacija dveh zdravil v majhnih odmerkih. Pri prilagajanju zdravila bolniku je treba upoštevati tudi druge bolezni in zdravila, ki jih bolnik jemlje, bolnikovo starost in verjeten patogenetski mehanizem njegove hipertenzije, pomembno pri izbiri pa je tudi, da zdravilo dokazano zmanjšuje srčnožilno in ledvično zbolevnost umrljivost.
Deskriptorji		HYPERTENSION ANTIHYPERTENSIVE AGENTS GUIDELINES