????? ????? ??? severe hypertension (260/100). ???? ?????? ??? ??? ??? ?????? (?????? ????? ACE, ???? ????? ????, ???? ???? ?????-????????? ???????), ????? ????? ??? ???? ???????.

1
???? ?? ??? ??? ?? ??? ??????

• ?"? ??? ???
• ?????? ?'

2

• ?? 70, ?4, ??????? ????? ?? ???. ?????? ??????.
• ???? ??? ??? ?? ????? ??? 6 ????, ????? ??? ?????
  ??????? ?????? (???? ???????? ???? 1.8).

3

• ????? ????? ??? severe hypertension (260/100).
  ???? ?????? ??? ??? ??? ?????? (?????? ????? ACE,
  ???? ????? ????, ???? ???? ?????-?????????
  ???????), ????? ????? ??? ???? ???????.
• ??????? ??? ???? ?????. ??????? ??? ????????,
  ??????? ?????? ?- Severe
• non-proliferative diabetic retinopathy.

4

• ????? ?????? ???? ?? ????? ???? ?? ???????????
  (LVH ??? ????? ?????????),
• ?-US ???? ??? ????? ?????, ??? RAS.
• ?????? ????? ????? ???????? - ??? ??? ?????? ????
  160/70. ????? ????? ?????? ?????? ?????? ????
  ?????? ????? ???? ??? ?? ?????? ????? ACE-I, ???
  ?????. ???? ?? ??????? ????? ?????? ??????,
  ?????? ????? ????? ??????.

5

• 3 ?????? ????? ???? ????? ?????
• ???? ?? ?? 250/110 ??????? ????? ???, ?????
  ????, ????? ????? ??? ???? ??? ?????????? ???????
  ?? ??' ????. ???? ????? ???? ??? ?????
  ???????????, ????? ?"? ?????? ??? ????? ?????
  ???????? ?????.

6
????

• ???? ?? ?????? - MILD MR
• ????? ????? ??? ??' ????, ?????? ?????.
• CRF Cr. ???? 1.8
• ?????????????? ?????? ???????.
• ???????????? ?????? ???????.
• ???? ?????
• COPD ?? ??? ????? ??? - ??? ?????.

7
??????

• T. SLOW K 600 mg x 1/d
• T. CLONIDINE 150 mcg x 3/d
• T. BISOPROLOL 10 mg x 1/d
• T. DISOTHIAZIDE 25 mg x 1/d
• T. SIMVASTATIN 20 mg x 1/d
• T. ELTROXIN 75 mcg x 1/d
• T. GLIBENCLAMIDE 5 mg x 1/d

8

• ????? ?????? - ?? - ??"? ??????.
• ?????? - ????? 40 ???? ?????. ?? ???? ???????.
• ?????? ??????? - ?? ?????.

9
??????

• ???? ???? 60, ??? ?? 255/107 ??? 36.8, ???
  ????? 12
• ???? ???? ???, ????? ????, ??? ???"?
• ??? ???? ?????? ??????, ??? ?????? ??? ?????????,
  ????? ????? ???? ??????
• ?????? HR ???? III, ??? ????????
• ????? - ????? ????? ????? ?? ????? ????? ????
  ????? ??"?, ??? ??????? ?? ???????.
• ?? - ????? ??????, ??????, ??? ??????.

10

• ??? - ???, ?????? ???????, ???? ?????? ????
  ???????, ??? ?????? ???? ????? ????? ????.
• ????? - ??? ?????, ?????? ????? ??????? ????????.
• ?????????? ????? ????, ??? ????? ??????? ??
  ???????
• ????? ?????? ??"?

11
?????

• ?????? 235, ???? 133, ????? 3 (????? ??????
  ????? ???? 4), BUN 43, CR 2.9, ?????? 170
• HB 14.6, WBC 11.4, ????? 280
• PT 10, PTT 26.5
• PH 7.4, 2PCO 40, BIC 24
• ??? ????? ?????gt300, ??? RBC, ??? WBC
• TSH 2, 4FT 1.2

12

• ????? ??? ??"? 2000 CC ? 24 ????.
• 13CCT
• PROTEIN IN URINE/ 24h 620mg

13
?????? ????????

• ?.?.? - NSR
• ????? ??? ?.?.?.
• ????? ??? ??? - ????, ????, ???? ????? TRANSVERSE
  LOOP
• ??? ?? LVH, ????? LA, AgtE, MILD MR

14

• US ????? ????? ????? (7.4, 8 ?"?) ????? ??????
  ?? ?????? - ??????? ???? ??????? ?????? ?????
  ?????? ????? ??? ????? RAS.???? RI ?????? ????
  ?????? ?- 0.85 ????? ?- 0.81 ?????.
• ????? ????? (TC 99M dmsa spect)
• ????? ?????? ??????? ?? ??? ??????, ????? ????
  ?????, ??? ????? ???????? ????? ?????? (???? /
  ?????)

15

• ???????? ???? 24h mcg20 (9-90)
• ALDOSTERONE 153 pg/ml
• (25-125 supine) (75-190 upright)
• PLASMA RENIN ACTIVITY 0.1ng/ml/hr -
• (0.5-1.9 supine) (1.9-3.9 upright)

16
????? ??????

• ?????? ???? ?? ???? 200/90
• ?????? ????? BUN ?, CR 2.9 ?2.2

T. CARDILOC 10mg X 1/d T. CARDORAL 4mg X 2/d T.
VASODIP 20mg X 1/d T. NORMOPRESSAN 0.15mg X
3/d T. FUSID 80mg X 2/d
17
??????

• ???? ?? 70 ?? ??? ??? ?? ??????? ????? ?????? ??
  ???? ?????? ???????, ????? ??????.
• ????? ?????? ?????? ?????? ???? ??? ?? ???? ???
  ???? ????.
• ????? ????? ????? ???? ??? ????? ???????.

18
Resistant Hypertension

• defined as BP gt140/90 mmHg in patients lt60 and
  gt160/90 mmHg in gt60, despite intake of 3
  antihypertensive medications.

19

• suboptimal therapy or poor compliance with
  medical or dietary therapy
• office or "white coat" hypertension
• pseudohypertension
• extracellular volume expansion
• ingestion of substances that can elevate the BP
• secondary hypertension

20
??? ??? ?? ????
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
Renal Parenchimal Disease

• ????? ????? ????? ???"? ???? (2-5)
• ??????
• Diabetic Nephropathy
• Chronic Glomerulonephritis
• Chronic Interstitial Nephritis
• Polycystic Disease

25
Renovascular Hypertension

• ??? ?????? ?????, occlusive vascular disease (IHD
  / ???? ????????????? / (PVD ?????? ??? ?????
  ???????, ????? ?????? ?? ???????? / ????? ???
  ACEI, ???????? ????? ?????? ?-US.
• 2/3 ??????? ???????????? (???gt 50, ????
  ??????). 1/3 Fibromuscular dysplasia (???lt 50,
  ???? ?????).
• ????? US ??????, ????? ?????, ???? ????????,
  MRA.

26
Primary Aldosteronism

• ??? ???"? ????????? (K? ????)
• ????? ?????????? ?????? ?? ??? gt 30.
• ???? ???? ????????? ????, ???? ????? ?????????
  ???? ??????? (2L Saline) ?? ??? ACEI, ????? ?????
  ?? ???? ???? ??? ????? ?????? ?? ??????.
• ?????? ??????? ?????? ???????.

27
Cushing Syndrome

• ??? ????? (????? ????????, ????? ??????,
  ????????????? ????)
• Screening ????? ??? ????????? ?? ???? ?????
  ?????????.

28
Pheochromocytoma

• ??? ??????????? ?? ?"?, ????????, ???? ????.
• Screening ????? ??? ????????????.

29
????? ?????
30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33

• ?????? ??????????????.
• ???? ????? ?????? ????? ???????? ?????????.
• ???? ?????? ???? ?? ???? ??????.

34
????? ???? ????? ???? ??? ?? ????

• Chronic arterial hypertension as unique symptom
  of brainstem astrocytoma (Pallini et al. 1995)
• Cerebellar tumor causing hypertensive crisis
  (Yagil et al., 1989)
• Cerebellar haemangioblastoma presenting as
  malignant phase hypertension (Mackay et al. 1978)

35
Increased Intracranial Pressure
Cerebral Perfusion ?
Vasomotor Centers
Sympathetic Nervous System Discharge
Blood Pressure ?
Cerebral Perfusion ?
36
??????
37
?????? ?????????????? ??"? ????? ?????, ?????
??????????