1 2 3
( 140 mmHg / 90 mmHg )
130 mmHg 80 mmHg
11 5 / 7 5
mmHg 130/80 mmHg
(Angiotensin-converting enzyme in- hibitors ACEI) Angiotension receptor blockers ARB
-blockers ( Diuretics ) Calcium channel blockers CCB 160/100 mmHg
( Diabetes mellitus, DM ) ( Hypertension, HTN )
( Cardiovascular disease, CVD )
( 140 mmHg /
90 mmHg )
3 0 . 6 %
140/90 mmHg 5 mmHg 20-30%5
130 mmHg 80
JNC 130/80 mmHg
4600 mg 2300 mg 5 / 2 - 3 m m H g
( A n g i o t e n s i n - c o n v e r t i n g e n z y m e i n h i b i t o r s A C E I )
Angiotension receptor blockers ARB -blockers ( Diuretics )
Calcium channel blockers CCB
dihydropyridine calcium channel blockers ( D- CCB )14,15
2 2 , 5 7 6
Verapamil SR-Trandolapril (IN-
VEST) verapamil (non- D-
ALLHAT ( antihypertensive and lipid-lowering treatment to prevent heart attack trial )
chlorthalidone am- lodipine lisinopril
SHEP ( systolic hy- pertension in the elderly program )
34% (p< 0.05)
110-129 mmHg 65-79 mmHg
methyldopa labatolol diltiazem clonidine prazosin
130/80 mmHg (C )
1. 130 mmHg
2. 80 mmHg
1. 140 mmHg
90 mmHg (A ) 2.
( ) (B )
3. 130-139/80-89 mmHg
(E ) 4.
) (A ) 5.
(E ) 7.
(A ) ( 2 ) 2
(A ) ( 4 )
1 1 0 - 1 2 9
mmHg 65-79 mmHg
(E ) ( 5 )
(E ) ( 6 )
(E ) ( 7 )
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3.Mathiesen ER, Ronn B, Jensen T, Storm B, Deckert T.
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2005 ADA Standard Recommendations for Treatment of Diabetes with Hypertension
Lyh-Jyh Hao, Chwen-Yi Yang1
, Chang-Sheng Ku2
, Kuo-Liang Chai3
Hypertension (HTN) (BP 140/90 mmHg) is a common comorbidity of diabetes, affecting the majority of people with diabetes, depending on type of diabetes, age, obesity, and ethnicity. HTN is also a major risk factor for CVD and microvascular complications such as retinopathy and nephropathy. Randomized clinical trials have demonstrated the benefit (reduction of CHD events, stroke, and nephropathy) of lowering BP to <130 mmHg sys- tolic and <80 mmHg diastolic in individuals with diabetes. Epidemiologic analyses show that BP >115/75 mmHg is associated with increased cardiovascular event rates and mortality in individuals with diabetes. Therefore, a target BP goal of <130/80 mmHg is reasonable. Nonpharmacological strategies include reducing sodium intake and body weight; increasing consumption of fruits, vegetables, and low-fat dairy products; avoiding excessive al- cohol consumption; and increasing activity levels have been shown to be effective in reducing BP in nondiabe- tic individuals and may also positively affect glycemia and lipid control. Lowering of BP with regimens based on antihypertensive drugs, including ACE inhibitors, angiotensin receptor blockers (ARBs), -blockers, diuretics, and calcium channel blockers, has been shown to be effective in lowering cardiovascular events. Systolic BP 160 mmHg or diastolic BP 100 mmHg, however, mandates that immediate pharmacological therapy be initiat- ed and should be seen as often as needed . In these patients, other cardiovascular risk factors, including obesi- ty, hyperlipidemia, smoking, presence of microalbuminuria, and glycemic control, should be carefully assessed and treated. Many patients will require three or more drugs to reach target goals. ( J Intern Med Taiwan 2005; 16:
Division of Endocrinology and Metabolism, Yung Kang Veterans Hospital
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi-Mei Foundation Hospital, Tainan, Taiwan
Division of Cardiology, Yung Kang Veterans Hospital