-
2 2008; 1-2
2007 (ESH) (ESC)
( ): G. Mancia (), G. De Backer (), A. Dominiczak,R. Cifkova, R.
Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, S.
Laurent, K. Narkiewicz, L. Ruilope,A. Rynkiewicz, R. E. Schmieder,
H.A.J. Struijker Boudier, A. Zanchetti
European Heart Journal (2007) 28, 1462-1536| 2007 .
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . 32. . . . . . . . . . . . . . . . . 3
2.1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . 3
2.2. . . . . . . . . . . . . . . . . . . . . . . . . . . 42.3. -
( 1) . . . . . . . . . . . 4
2.3.1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . 42.3.2. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . 52.3.3. . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . 8
3. . . . . . . . . . . . . . . . . . . . . . . . . . . . 93.1. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . 9
3.1.1. ( 2) . . . . . . . . . . . . . . . . . . . . . . . . .
103.1.2. ( 3) . . . . 103.1.3. ( 3) . . . . . . . . . . . . . . . .
. . . . . . . . 113.1.4.
" ". . . . . . . . . . . . . . . . . . . . . . 123.1.5.
. . . . . . . . . . . . . . . . . . . . . 123.1.6. . . . .
133.1.7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . 14
3.2. ( 4) . . . . . . . . . 143.3. ( 5) . . . . . . . . . . . .
. . . 143.4. ( 6). . . . . . . . . . . . . . . 153.5. . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . 163.6.
- ( 7) . . . . . . . . . . . . . . . . . . . . . . . . 163.6.1.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . 173.6.2. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . 183.6.3. . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . 193.6.4. . . .
. . . . . . . . . . . . . . . . . . 203.6.5. . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . 20
4. . . . . . . . . . 204.1. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . 204.2. . . . . . . .
. . . . . . . 214.3.
. . . . . . . . . . . . . . . . . . . . . . . 224.4. -
. . . . . . . . . . . . . . . . 224.4.1. -
- . . . . . . . . . . 224.4.2.
-. . . . . . . . . . . . . . . . 234.4.3.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . 234.4.4.
. . . . . . . . . . . . 234.4.5. - . . . . . . . . . . . . . . .
. . . 244.4.6. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . 24
4.5. - . . . . . . . . . . . . . . . . . . . . . . . . . .
25
4.5.1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . 254.5.2. . . . . . . . . . . . . . . . . . .
274.5.3. . . . . . . . . . . . . 284.5.4. . . . . . . . . . . . . .
. . . . . . . 284.5.5. . . . . . . . . . . . . . . . . . . . . .
30
5. . . . . . . . . . . . . . 305.1. . . . . . . . . . 305.2. (
8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
5.2.1. . . . . . . . . . . . . . . . . . . . . . 32
5.2.2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. 33
5.2.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
5.2.4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . 345.3.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . 346. . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . 35
6.1. ( 9). . . . . . . . . . . . . . . 356.1.1. . . . . . . . .
. . . . . . . . . . . . . . . . . . 356.1.2. . . . . . . . . . . .
. . . . 366.1.3. . . . . . . . . . . . . . . . . . . 366.1.4. . . .
. . . . . . . . . . . . . . . . . . . . 366.1.5. . . . . . . . . .
. . . . . . . . . . . . . . . . . 376.1.6. . . . . . . . . . . . .
. . . . . . . . . . . . . . . 37
6.2. ( 10 11) . . . . . . . . . . . . . . . . . . . 376.2.1. . .
. . . . . . . . . 376.2.2. ( 12) . . . . . . . . . . . . . . . . .
. . . . . . 416.2.3. ( 12) . . . . . . . . . . . 41
7. . . . . . . . . . . . . . . . . . . 437.1. ( 13) . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . 437.2. ( 14 15) .
. . . . . . . . . . . . . . . . . . 457.3. ( 16) . . . . . . . . .
. . . . 46
7.3.1. . . . . . . 467.3.2. . . . . . . . . . . . . 47
7.4. ( 17) . . . . . . . . . . . . . . . . . . . . . . . . .
48
7.5. . . . . . . . . . . . . . . . . . . . . . . . . . . 497.6.
( 15). . . . . . . . . . . . . 497.7. ( 18) . . . . . . . 49
7.7.1. . . . . . . . . . . . . . . . . . . . . 507.7.2. . . . .
. . . . . . . . . . . . . 517.7.3. . . . . . . . . . . 51
7.8. ( 19) . . . . . . . . . . . . . . . . 537.9. ( 20) . . . .
. . . . . . . . . . . . . 557.10. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . 567.11. . . . . . . . . . . . . . . . . . .
. . . . . 56
8. ( 21). . . . . . . . 578.1. . . . . . . . . . . . . . . . . .
. . . . . 578.2. . . . . . . . . . . . . . . . . . . . . . . .
588.3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . 59
9. . . . . . . . . . . . . . . . 599.1. . . . . . . . . . . . .
. . . . . . . . . . 599.2. . . . . . . . . . . . . . . . . . . . .
. . . . 599.3. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . 609.4. . . . . . . . . . . . . . . . . . . . . . .
. . 619.5. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . 629.6. . . . . . . . . . . . . . . . . . . . . . . . . .
629.7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . 629.8. . . . . . . . . . . . . . . . . . . . . . . . . . .
62
10. ( 22) . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . 6211. ( 23) . . . . . . . . . . . . . . . . . . . 63
-
2008; 1-2 3
1. -
(ESH) - (ESC) , - - (ISH) [1,2], - . 2003 - ESH/ESC [3], /ISH ,
- , - -, - . - - - - (), - .
ESH/ESC 2003 [3] - - [4]. 2003 , - .
, - ESH ESC, - 2003 : 1) - - , ;2) - - ( ), , 2003 [5]; 3), , ,
-, , - ; 4) - , - - (, , ) ; 5) - [6]. , - , -, . , - - -, - .
, ESH ESC, , -
. - - - ( , -, ), , . - . ESH ESC(www.eshonline.org
www.escardio.org) - -. ESH ESC.
2.
() -- , - [7]. - JNC ( - ), - [8,9]. - - [10]. - , - , [7,11]. -
-; [7]. ( ) (.. , - ) , -- [12]. , - - -, - [13-16]. , - -- . ,
[17-19] , - - [20].
2.1.
, - -
2007
-
2007
4 2008; 1-2
, - - [21-23]. (- ) [24-27]. - . - - (61 , 1 - -; 70% ) [11], -
; , - 55 . , [24,25] [26,27] , - - - , - [24-27].
, , - . - 50 55 . . [28], - . 3.1.7, , ( - ) .
(. 2.2 2.3) - - . - , -, -- . - - , . - - - - [28] (. 3.6).
2.2. -
[29]. - 115-110 75-70 . ., - [7,11]. , , - , - . - ,
. , ESH/ESC 2003 ., (. 1). - :
1. , - - -, .
2. - ( 1, 2 3) - ( ). , - (, 60-70 . .) - .
3. - - . -, - , - . , , 5.
(JNC 7), 2003 . [30], -, [31,32] , - , 120/80 . . ( - ). ESH/ESC
- :1) - (130-139/85-89 . .) , (120-129/80-84 . .) [32,33]; ;2) - -
[34]; 3) JNC 7 2003 . - - [30], . - - (, 120/80 . .), - (, - ), , -
.
2.3. - ( 1)2.3.1.
-
2007
2008; 1-2 5
.
JNC 7 [30], ESH/ESC 2003 . [3] , - - . , , - - - [35-39]. [40].
, - - [35,41,42]. , , - , , - , [3]. - , - - [43,44].
2.3.2. - -
: 1) - - -; 2) 2- ; 3) 1- ; 4) . -- , - (. ). , - .
- - , .. - 10 . -
-
6 2008; 1-2
[45], - ( - )[12]. , - SCORE [46]. SCORE, - - - . -- ( ) 10 , -
- . SCORE - Heart-Score, ESC -- (www.escardio.org).
ESH/ESC 2003 . [3] -- /ISH [2], - . - (. 1). , , -- - 10 -- ,
-
[45] SCORE [46]. , , , - . - , - -, , . /ISH 2003 . [47] - , . ,
.. - - - . - -- , - - . . 1 -, - , , , [48].
. 2 -, - . (-, , -
2007
. 1. - 4 . , , . - 10 . , . - .
, - --
120-129 80-84
130-139 85-89
1 140-159 90-99
2 160-179 100-109
3 180 110
1-2
3 , - ,-
-
, . .
-
2008; 1-2 7
2007
- , , , ), -- - , - 2003 . [3]. - :
1. [49] - , -
-- . , .
2. - -, - -- [50]
2. ,
( ) > 55 > 65
- >5,0 / (190 %) - >3,0 / (115 %) - < 1,0 / (40 %)
< 1,2 / (46 %) - > 1,7 / (150 %)
5,6-6,9 /(102-125 %)
(
> 102 > 88 ) -
(< 55 < 65 )
-
- ( - > 38, > 2440 ) :
* ( 125 /2 110 /2
) ( -
> 0,9 ) -
> 12 / - < 0,9
115-133 / (1,3-1,5 %) 107-124 / (1,2-1,4 %)
** (< 60 //1,73 2) *** (< 60 /)
30-300 / / 22 / 31 /
7,0 / (126 %)
> 11,0 /(198 %)
3- 5- : , , 130/85 . ., (. )
-
: , ,
: , , ,
: , ( > 133 / > 124 / ), > 300 /
: ,
* : > 0,42. ** MDRD . *** -. , , , ,
-
8 2008; 1-2
2007
. 3.6 - - -.
3. , - [51], , - MDRD [52], - -- , .
4. -, - .
5. - , -.
6. , - (, , - ), - [53].
7. - , - [54,55], - .
8. - (< 0,9) - - - [56].
9. - ( ), , - - -- [557-61].
10. () , - - , [62-65]. [66,67] - [67-69]. , - (60-90/), -, - -
.
11. . 3 - . -
, - , - - , .
2.3.3. --
- - , - (, - ) [70]. , - - . . 2 - - , - ( -, -, , , -, ..). - -
. - 3.6 . 4.
- . - - --
180 . . /
110 . .
> 160 . .
(< 70 . .)
3- -
,
-:
( )
( , )
);
;
;
;
;
.
-
3.
-
2008; 1-2 9
2007
, .. - . - - , , - . (20%- - 10 ) ; - , , , -. , - -. ( ) - , (
)., 70 - , - . , , -, , , -, - , - - . - ESH/ESC 2003 . [3], -, - .
- HeartScore(www.escardio.org) - - -
, [71]. - , , - , - , -, - - - . , - , , - -.
3. : 1)
; 2) ;3) - - , -- . - :
; ; ; .
, - , .
3.1.
, , [72-74]. - -
++ ++++ +
+++ +++ ++
- +++ +++ ++
( ) +++ + ++
- ++ ++ +
+ + ++++
/ ? + ++
? + ++
++ + +++
/ ? ++ ++++
+++ ++++ +
+++ ++++ +
4. , -
( 0 ++++).
-
10 2008; 1-2
. - , - , . , , - - , - . , - , , 2- - 3- , - . ( ), - . - -
[75] .
3.1.1. ( 2)
-, ( , , ..) . - ( - ), - - . -
[76] (www.dableducational.org), - . - - 2.
3.1.2. ( 3) ( , -
) . - , - , . - . , - , - [77-79]. - , (1) - - - , [80-85]; (2)
- - -, [86-89];(3) , - [97,98] - [99] [100,101]. - [82,98], - . 24,
, , . - [78,79], [87,89-94,94]. , , [102], -- ; - - ,
[87,88,90,92,93,103-106]. , [107-110], , - [72,111-113], ,
[114-118]. -
2007
2.
.
, , 1-2 ; , .
12-13 35 . . .
.
I V , .
, , . .
, , , , 1 5 .
( , , 30 ) .
-
2008; 1-2 11
2007
- - - ( -) [119-121]. - -, - [122].
- [75]:
, - ;
( - 5 . .);
, 30 , , - - - ;
2 . ./;
, ; - - ;
, ;
, - - 30% . - ;
, - . . [123-125]. .5, , 140/90 . . 125-130/80 . . (130-135/85 .
. 120/70 . . ). - ;
, , -, / . (, - ) -, .
3.1.3. ( 3) -
, . -
-. - -, , ( - -, -- ) [81,89,90,92,126,127]. -, - , - -
[128].
- [75]:
. , , -
3.
, - .
(. 5).
, , :- ;- ;- , ;- ;- , ;- .
. :- ;- ;- .
, :- ;- ;
(. 5).
-
12 2008; 1-2
2007
[76]; - , ;
- , , , - , ;
- (- ), . , - - ;
. - , - ;
(130-135/85 . . 140/90 . .) (. . 5);
- - .
3.1.4.
- , - . [129], , [130], .. [131,132]. - - 15%. - ( )
[106,133,134]. , - , , -
, [90,92,106, 133-138]. ( ) -, -- , . - , - [133]. - , -
[92,106,133,138]. , - - - - [133].
1- (), - , , - , , [75]. , 140/90 . . , - , , - . - - (
-
2008; 1-2 13
2007
- [133]. - [142], - -- [139] [133] - . , - , - , ,
[92,106,133,134,137,141].
, - - - . - 12- , / - - [133]. - - , - -.
3.1.6.
, - -. - ( ) - , ,. [143].
. - , -, - .
[144]. - - [145], - 10 [146]. - , - [147] .
- - - [148-154]. - , [155]. - , - - [156], - , , [153], - [157].
- , [158], - [153,157].
, - - , [149,159]. - 21- , 6-- -- , - [160]. - . - - - . - - (
-), - . - [159,161].
, - -- . , 21- - [160], - - -- , , , - . ,
-
14 2008; 1-2
2007
, , , .
3.1.7.
(.. , - ) [162]. , - - [163]. - - . - , [164,165]. - , - -
[166,167]. , , - - [166]. - .
3.2. ( 4)
- . , , , , -, - .
: 1) ;2) , , ( , , , , , , , -); 3) ( , -, , ); 4) , , - , - , ,
,, , -, , - , 5) - , ,6) , , --
, . , , -- .
3.3. ( 5) , (
30 ), - , - [62-65] -. , -. - , , - .
4.
1. .
2. :. ();. , ,, ( );. (, , ,, , , , ,);. , , , ();. ().
3. :. - ;. ;. ;. ;. ;. , ;. , ;. .
4. -:. : ,, , , ;. : , , ,;. : , , , ;. : , .
5. : , ;
6. .
-
2008; 1-2 15
2007
3.4. ( 6)
, -. -. , , - . . -, - , - : , -, , , - (), , , , - , - (),
. . - - . - - - MDRD[51,52]. - - , - (. -
5. , - .
-:
-;
();
();
( );
( );
( ).
-:
: , ;
: ;
: , , , , ;
: , , , ;
: .
:
;
( 102 88 );
[ , ()/, ()2]:
25 /2 30 /2
6.
:
;
;
;
;
;
;
;
;
( -) ( MDRD);
;
( - );
.
:
;
;
( - );
- ;
;
( 5,6 /, 100 %);
;
().
:
, , . !
, , : ,, , / , , , , - .
-
16 2008; 1-2
2007
3.6.3). 5,6 / (100 %), [168]. - 7,0 /(126 %) - [168]. - - , (),
- [169], - - [170]. , [171,172]. (-, , , - .) [173] -, -.
3.5. -
, . . - [174,175]. - - . , , , . , - , , . - [176]. - , . -
[177].
3.6. - ( 7)
- - - - -. -, . - - -, .
1. - -
, , [178-184]. - -
7. -
- - - - .
1. . - - , , . , - . - , - - . .
2. . - , - . ( - ) . - .
3. . - - . - ( - MDRD , ) - ( - - ). -. - , -, - .
4. . - -. - ( -). , - , , - - .
5. . , - , - , - . - - - .
, - . 4.
-
2008; 1-2 17
2007
[181,182,185,186].2.
[187-189], - [190-193]. - , - [194]. - , 50% - , - [194].
3. - [57-61,195] , - - . - , -- - , - - .
, 2003 . [3], - , - - . - - , - , - . - , - , -- -, , , - - . -
. .
-- .
3.6.1.
. - , , , - -(SV1+RV5-6>38 ) (- QRS > 2440 ), - [187] -
-
, , 55 [195,196]. - ( ) [187], , - , - , . , - , [72]. , -
[197-199].
, - ( , - - ..), - [200] -- [188]. - [194]. - , - [201]. -- , -
- 125 /2 110 /2 . -- - ( 0,42 ) [202], - (
-
18 2008; 1-2
2007
- [208]. , ( 50%) - ( - ) [209]. - ( ) [210]. , - . , [211]. , -
, - [206] - [212], - [213]. , - - , - , -- [214-216]. - , , .
, , - , -, -. - , - , - .
- [217,218]. , - - , , -, [219]. , - -. - [219], - .
3.6.2. -
. - - () - - , -
[190-193]. - - , - 0,9 . - , - , , / - , [220-222]. - 1,3 1,5 -
0,5 50% [220-222]. - , - - . , - [194]. - - - 0,9 ( - ). -- - [56],
- [220]. -- , , - - [15,223-226]. - [227].
10 - - , -, - [228]. - -, . - , - - [28]. -- , - -
[54,55,229,230]. - -, - - 12 /. -
-
2008; 1-2 19
2007
, , - .
. 4, - . - - , . - [231-234], - - [235]. - . - , - - , - [236],
- . - - - [237,238], [239]. , - , - . -, - . , . -, - , [240]. - .
.
3.6.3.
/ - [241]. - , MDRD , , - [52]. 60 //1,73 2 - 3- -; 30 15 //1,73
2 4- 5- -, [242]. - -, , - [51]. 60 /, - 3--5-
[242]. - [242]. - - - [243].
( 20%) , . - ( ), - [244].
- ( ) , - - . (. . 2) 1- 2- [245], - [246]. - , -, ( - [247]) --
[178-186,248]. - - -/ (3,9 /) (7,5 /) [185,186]. , - (, -) - [248].
- (- ) - [242]. - 300 / , - - 30 / -. - -, .
, , -, - - , [179,249-253]. - ( -). - ,
-
20 2008; 1-2
2007
- , , . - .
3.6.4. 30- . XX Keith, Wagener Barker -
[254], - , - (3- ) (4- ) -. 1- ( ) 2- - ( ) - , --, ( , -)
[255]. - [255-257]. , - . , 3- 4- - [258,259]. - - [269]. , - - . -
, [261]. - [262,263]. - .
3.6.5. , , ,
- [264,265]. () -, -- (). - . - . , , ( ). - , , - -
[266,267],
. - , - [267-269]. - , - , . - , , - [270-272], - .
4.
4.1. -
, - . - , , [3,273,274].
, - , - - -. , -, . -, - -. , - , , - , - , - . , - - - , -
.
, ( - 4-5 ), - 20-30 . - , [275,276].
-
2008; 1-2 21
-, -.
- - , - -. -, ( , - ). , - - - , .. . - - ( 3.6 4.5). , - -- ; -
. - , -. - , , - . - - - [186,277]. - . , - 4.5.5.
- , - . - - , , - , . - , , - , - . -, , .
4.2. -
, , [278-291]. - - [10,292-299]. :
1) - - - , ; 2) - , - ; 3) - , - , ; 4) - - (- 30-40%) - ( 20%).
-, - .
- - - , , . , - - - , , - -. - [292,293].
- - , .. - . , . - - , , - . - HOPE -- ( , ), -- , - ( 3 . .) (
22%) - [300]. FEVER - , 160/90 . . - [301]. - , (3,5/1,5 . .).
--
2007
-
22 2008; 1-2
28%. EUROPA [302] , -, ( 5/2 . .) - ( -) -- . ACTION - - - - --
( ) [303,304]. - CAMELOT , ( - . .) - [305]. [306].
- , - . SCOPE [307] 70 ( - ) - , - ( 3,2/1,6 . .). - . RENAAL
IDNT , 2- , [308] - [309] - - ( ), - -- ( ). , - -- - [310]. -, ,
.
4.3. -
, , HOT [311], , , . 5- -, 22 000 , - Blood Pressure
LoweringTreatment Trialists' (BPLTT) [292,296]. - -
-- , -. - (. ), - - . , - - , HDFP [312], - , . - -, , - (.
4.4).
4.4.
ESH/ESC 2003 - , - [220,222,292,313,327]. . - , - BPLTT, ,
[328,329].
- , - , -. , - - [273,274], - . - - - , , - , , - -. , - , - -
-, .
4.4.1. - -
9- -, - 68 000 [292]. -
2007
-
2008; 1-2 23
. - , , - , - - . - - , -. , [296]. ASCOT , - () [330]. INVEST,
-, - - , - (, - ) - (, ) [331]. - - , , - . -, ASCOT ( -/ -/
-).
4.4.2. - -
- BPLTT 6 - , 47 000 - [292]. , - - , -, - ,- . - - - . -- , -
[296].
-, . - [327] , , - - , - . -
, - - . ALLHAT [322], , ( ) , - - ( ).
4.4.3.
6- - 26 000 [292]. -, - , . , - -.
4.4.4. -
5- - . - - . LIFE [332] 9 000 - - - , - - . - 5- -- ( ) 13%. ,
25%. ( ) SCOPE, - - , [307]. MOSES [333] 1 500 , -, , - -. 2,5 . .
- - , - - . JIKEY HEART [334] 3 000 (, -, - ) 139/81 132/78 . . 3
-
2007
-
24 2008; 1-2
(40%) , ( )., , VALUE [335] - 15 000 , - . 5 - , . - ( ) -, - .
, - - . - - - , [296].
, - [336]. - -, [337,338]. - (.. , - ) - . ONTARGET, - , - ,
[339]. - - , - - [340-342]. - BPLTT - , , , - , - , - [329].
4.4.5. - - -
- LIFE [332] ASCOT[330], , -, - - (LIFE) - (ASCOT). - - [343], -
, , - -, - , . - NICE - -- - [344]. -, -. LIFE ASCOT , - , - -, - -
-. ALLHAT [322], - - . INVEST[331] -, - , - - , , . , -, - , - -
[297]. - , -/ ASCOT, , [330] ( - [166]) .
- - - (4.5.5) , - . , -- -[297,343] , - - , .
4.4.6. -
2007
-
2008; 1-2 25
, - , - , . - , - . - - , - , .
, [292,328,329] - - , -: 10 . . - , , [328,329]. - , - - (.. -
). (5-10%) - , . , - - [292,296] , - /--, - ( - ). - , , , - . - ,
, , - , [3,345,346]. , , VALUE [335], - - . - - - . , , - -. ,
ACTION , , 14,6/7,6 . . -
- 38% [304].
4.5. -
- - -- . - - - - [274]. , - -.
4.5.1. -
, . - -, - . - . - : 1) , ; 2) -, , 9-12 .; 3) - ; 4) - , - -,
[347,348]. , - - - [349].
, . [350-352] (-, , -) (, - , ). - [347] - , [353] - - - -.
[354-356] -
2007
-
26 2008; 1-2
- (, -, ) - ( ). LIFE 960 - - [357]. - - (-/) - - , - -
[358,359] - [360]. - -, - - . - [361] - , , ( ). - - - -, - -,
[362].
, , , - , - . - , - , - , , , - -. [363] , - -. , , .
[353,357] - , - , - 2-3 . LIFE -, - - - ,, - [57], -
[61,364,365]. -
-. - , - [347,356], , ( ) - [217,219,366], - [367]. - ( I III )
, [219], [368]. - - [356,369], -.
- - . LIFE - -- [370]. - [357]. - - - [195]. - - [371], -
[372].
, - ( ) [210]. - - (, ) , - [356,373]. , - -. -, -
2007
-
2008; 1-2 27
.
, [374] - - [375]. , - [376]. [377,378] , - - - -. , [379] -
[380] [381] -. LIFE - - [382]. - - . - [383] [384]; - . , - - - - (
-, - ). - -. - .
4.5.2. - ,
-- [386], - , -. - , - , -, - ., , , - ( ), -, - ,
/ ( ).
- - - - [387,388] - [389]. - [390], - [391], - [220,221] [392].
-, , ( -) , , - .
- - / ( - ) - - [393], [394] - [389], , , - . - , - , - [395],
[222] [220,221]. [390]. - ELSA [220,221] , - - - . [396] - [397]. ,
- , - . - -, -, .
- , - . - -, , - (.. ) - , .
2007
-
28 2008; 1-2
( ) , - - [398], - -. -, -. - , - [399]. , , . 4- [400-403], ,
-, - .
4.5.3.
- [404]. - PROGRESS - ( ). , - 11/4 . . [405].
- , - [406]. - 13 143 - Mini Mental State Evaluation
[283,407,408]. , 4,8/2,6 . . 5- - 717 3,2/1,5 . . - [409-413]. , 4-
- 2 396 17,1/7,0 . . -, - . -, , - , - - . - . , - - . , , -
, - , J- [406].
, -, - . , - -. , - , - - , - [275,407].
4.5.4. -
(- , ) -, , - . , , - , [415-417]. - [418,419].
, ( 130/80 .., 140/90 . .) - . - - [3,30,420], , - . , , - MDRD
[421], - ,, , -, 92 ..(.. 120/80 . .) 107 . . - (.. 140/90 . .). -
- [318,422] - . - - 120/80 . . -
2007
-
2008; 1-2 29
( 120/80 . .). , [423]. [424] - - . , - MDRD -, IDNT [425] 11-
-, , , 120 . .[426]. , , - , , - ( 130/80 . .) -
[311,422,427-429].
- - , . - , -, - - - - [308,309,428,430-435]. - [436]. - (
[430]) - - , - , , - . SYST-EUR - - [437].
-. ( [309], - [317]) - - - - . , - ALLHAT -
( - ) - , [439]. -, , : - , - - [317,318]; [319,422], - [316], -
[439], -/ [438]. - [322].
- . - , -[440], [441] - [443]. [432,443]. , - [319,422,444],
[445].
, - - ( ). COOPERATE - - , - [446]. - - - [447,448]. - - , -
[449]. - [450] - , . - , - , - - - , [451,452].
2007
-
30 2008; 1-2
.
4.5.5. -
[453]. [454]. -, - ( ) - [455]. , / --, , [313,322,327,456], -
[307,332,457] [315,321,322,331]. -, - [335] [322] - , . , - - - , -
[455,458]. , (SHEP), , - ( -)[459]. MRC [288]. -- [460], - , --. -
-- [306,461,462] - [463] , ( -) , - -. - DREAM [464], - - . , -. -
-. - 22- , - 160 000 [460], ,
- - . ,- .
, - -. , - - -, [322]. - , - 10 - ; - [465]. - (16-30 ) - -- , -
( /-) [466-470]. - 14- SHEP[459]. - ( ) . , , . , , - . - , - . - -
, .
5.
5.1.
: 1) (. 1) 2) - (. 2).
, 2- 3- , - , ( - ESH/ESC 2003 [3]) - , - - , ,
2007
-
2008; 1-2 31
2007
(, )[10,23,292,471]. 1- - , . FEVER -, 140 .. - [301]. - 140
..
- - , - - . VALUE - - [335]. - ASCOT ( - -- , VALUE) - [472].
-
, (. 2) [3]. - 3- , 1- 2- - . 1- 2- , -, , 1- - ( ) . , - .
(130-139/85-89 . .), - . - [283,300,302,308,319], -, , - - -- ,
-
. 2.
,
-
120-129
80-84
130-39
85-89
1- 140-159
90-99
2- 160-179
100-109
3- 180
110
;
,
;
,
+
1-2
;
,
;
,
+
3 ,
-
;
+
+
+
+
-
+
+
+
+
+
, . .
-
32 2008; 1-2
2007
[306] -- - [304]. - (
-
2008; 1-2 33
2007
, - , - . INVEST - - - [478]. .
-
34 2008; 1-2
2007
- - (50% HOT), - . , , - [482,483] - , . , - , - . -, , , . -
5.1, - [302,304,305] -- (EUROPA: 128/78 133/80 ..; ACTION : 137/77
144/81 ..;CAMELOT: 124/76 130/77 ..), - - (129/74 132/76 . .)
[306].
- ( - -) , , 130/80 . . - , ( 4.5.4).
5.2.3. , -
- , - - . - - -- [88]. - , , . - . . - (. 5), - [484], .. -
[77]. , - , -, [485], - , - , , - .
5.2.4. ,
, , 140/90 . . . - - ,
-
2008; 1-2 35
2007
, - - [494]. , -, , - , - ( , , NNT) [495]. 1) - - , - , -
(inten-tion-to-treat) [273]. 2) - , - - . 3) , - 5 , - - [274]. , -
- , - [496]. - - - , / -, -, , - . - , HDFP [312] HOT[497], , , -,
- - , . , - - - , - . -, - , . , , - , [498,499].
6. 6.1. ( 9)
, -, - . , -
, - . , - - , - : 1) , 2) , ; 3) - ; 4) ;5) ; 6) - - [500]. -. -
- , [501]. - , - .
6.1.1. , -
15 [502]. , - [503,504]. , - , [505]. - , - - , [506-508];
9.
, . - , .
- .
, -- , : ; ; ; ; ; .
.
, - , - , - .
-
36 2008; 1-2
2007
, [502]. - [509], [510], - [511].
- [512], , --, - - -, [512-514]. , , - , , [515,516]. .
- [517] [518]. - , - - [519]. - [520,521]. - . , .
6.1.2. U-
J- - . - , [522]. -- [523]. - , [524]. , - [525], - . - , - 1-2
80% [526]. , , . , - , , . [500]. 20-30 , 10-20 . -
-.
6.1.3. -
, - - [527,528]. [500] 80-100 (4,7-5,8 ) - 180 (10,5 ) 4-6 ..
[529-533], . - , - . , - , , -, .. , -- [534]. - - [536,537] - - .
- -. , [537]. - . - 100 65 /, 3,8 . . - 5 / (85 /) [538].
6.1.4. , -
, , - , [539]. - - , -3 - ( ) , (3/) [500,540,541]. 4,0/2,5 . .
[542]. - - [543,544]. - , - [500,545,546],
-
2008; 1-2 37
2007
-, , - [500,547,548]. (4-5 300 - ) [549], [550] - . .
6.1.5.
[551]. [552]. , - - (-, , , - ). -, 5,1 4,4/3,6 . . [553]. , . -
[554,555,556]. - - - [557], - - [558,559]. ( 0,5-1,5 /); - .
6.1.6.
- , [560]. - - - [561] , - 3,0/2,4 . ., 3,3/3,5 . . ( 6,9/4,9 .
.), ( 1,9/1,6 . .). [562], , -, - . , , , - , , 30-45 [564] (, ,
-
) [144,564,565]. - , , -- , . , - , , . -, , - . , - .
6.2. ( 10 11)6.2.1.
-, - , -, ESH/ESC 2003 .:1) - , , - -; 2) ( ), -, , - - -- . , -
-, . - -, , - - .
[330,332] - - [343] , - - , . - -, - , - [482,483,567]. -- - . -
[568], ( ) - [455,458], - , - (- , -
-
38 2008; 1-2
2007
, - ), [569,570]. ,
[455]. -, , - -, . -, ( -), - , , -- [571,572]. -, - - , - -
[299,573].
, - -, : - - [349], [219,367]; , - - [308,309,430-432,437],
[308,309,430,431,434]; - , - [220-222,391,392,395].
- .1-, ( 2- - ) - [574]. - [575]. , - 1- ( ALLHAT), [576], - . -
. - , - . , - . 1- - . , [577].
10.
- -.
5- -, , , - - - . -, , - , .
-, , , . , - .
- :
1. ;2. -- ;3. --, - , - - ( 11 . 6);4. (. 7);5. - , - ;6. , - ,
-.
- , . , .
24 . , - .
- , , - .
-
2008; 1-2 39
2007
- . , - [578-580]. - - [581]. , , - [577], - II [582], . - .
, . - , [583]. , , - , , , . - ( -) ; . , -
, --, . - -. : 1) - ; 2) - , - ; 3) - -, -- , -; 4) ; 5) -, ; 6)
, , . - , - . - - [584], - -
11.
-
, ,
,
,
,
-
-, ,
-,
, -, , ,
, -,
/ , ,
() ,
, ,
,
, , -
,
II
-
40 2008; 1-2
2007
- - II-III
()
( )
- II-III
( )
7.
()
-
()
()
/ -
(/)
/
/ -
, -
( )
6. ,
-
2008; 1-2 41
2007
[88]. , - [585].
, , - . , , . 6 7 11, - - 7.
- , , - [584,585]. - , [291]. - - - . -, - ( - ) [587].
6.2.2. ( 12) ,
. , ( , ). - , - . - , - - . , - ( , , 20 10 .., ) - 50% [588],
, ( 140/90 . .) 20-30% ( 1- ) [589,590]. , - , , - - , - -. -, ,
,
, . - .
6.2.3. ( 12) -
-, , -. - , -, , - , - [311]. , 90% - , , - ,
-
42 2008; 1-2
2007
, . - : 1) - , - ; 2) - -;3) -, - ; 4) - - , . -, VALUE - - (
3,8/2,2 . .) 6 -- [335]. - , -, -, .. ( 20/10 . . -) , , - , -, - .
, .
, 1) -
; 2) -, - ; 3) - . - , - . . 4:
; -
; ;
; ; - (-
). --
- , , ( 4.4.5 4.5.5). - - , - , - -. - (, -) - , - [591], -
-
: / -
2-3-
/
. 3.
-
2008; 1-2 43
2007
, , [592,593]. - - . -, - , , -, [446,594]. , - [595]. , - - -
[449,596]. - ONTARGET [339]. - , - , - . . 4.
, , - , , - - , - , - - . , - , -, - [584,597].
, - , - . , - , , - - , . - ACCOMPLISH [598], - , - , - - .
7. 7.1. ( 13)
- - - [294,471]. , - 60 70 . - - , - 80 , [599]. - , - HYVET
[600].
-
-
II
. 4. .
. ,
-
44 2008; 1-2
2007
-, - - - , - [281,282,287,288]. - - , -- -- , - - [601]. [280] -
[284]. - -[285] [286]. - ( -). . STOP-2 [314]
- , , -, ALLHAT [322] - , - - 65. LIFE [332] 55-80 - -- , , -, -
; - - [602]. SCOPE [307] - 70 , - ( , - -). - - 42% [603]. , - , ,
- , -, -, - . - - [344].
-. , - [604]. , -, -- - , . - -. - , - - 140 . . [492,605].
, - , -. SHEP - [606]. , - 70 . ., - 60 . ., - . -
13.
-- 60 - -- .
, - , -, - - . - - , - .
- , , - , .
(
-
2008; 1-2 45
2007
. Syst-Eur - 55 .. ( ), - [607]. - - - - , .. - . - - - -- - 60
120 .., [487]. , - , . - , -, - .
7.2. ( 14 15) . 1-
- - - , 2- - - - - , [168]. 2- 10-20 - 1- . 70-80% [453].
- - , , , - - [454]. - 3.6.3, - [245] -- [178,186,248]. - - 1- ,
, - [434,608].
, 4.4, , 2- - - - (-) -
(-) [296,609]. - ( -), - . , - - . - - , - 2- - , [296]. , - 5.1
5.2, - 130/80 .. . - - ( 4.5.4).
2- - , - . 4.5.4, -
14.
- ; 2-.
-
46 2008; 1-2
2007
, - .
, , 2-
-
2008; 1-2 47
2007
30%. - , . - - HOPE , - [611]. , - , 140/90 . . (. 5.1).
2003 . - , - . - PROGRESS , [283], - [480]. - 12,3 . . - 43% (
36% - 76%), - - (5%). , - , , , PROGRESS [480] - , 130 . .
- . - SCOPE , , , - - - [612]. 4.4.4, MOSES [333] , - , - - -
31% , (12%) - . , - , - - .
- - . , -
( - ), [613]. - 339 - -- 12 . [614]. - ( , - ), - . - , -
[615,616]. , - [614]. , , - , . .
7.3.2. , -
, - , [270-272]. - , - - , - - [270,617-620].
- , - - ( - , ) . 4.5.3 - - [406], -, , , - [406]. , , . - - , -
, -
-
48 2008; 1-2
2007
15% 65 , - 5% - 25% 85 [621].
7.4. ( 17)
[622]. - , [623,624]. - - -, - - - - [340,341, 482,483,625]. - -
-, ; - . , -, -, , .
, - , -, -, , -, - [482,483,625].
4- - 4.2. [302-305], - [306], - . - INVEST. , - - - - , -
[478].
INVEST - - - ( ) ( -) [330]. ALLHAT - -- , - [322].
, , , -. , , . , - - .
, - . - - - . - , -, , ( ; . 4). - , - , . - , ,
17.
, , - -, - . - , .
. - ( ), -, . 140 . . 130/80 . . .
, . , -, , -. , .
- , - . .
-
2008; 1-2 49
2007
(. 3.6.1). , - - - [626]; , - -.
7.5. -
[627]. - - 2-5 - [628]. - - - [215]. . , , - 140 . . [629]. -
[376-378] - (. 4.5.1), , .
- - [383,384] (. 4.5.1). - , . - - , . -, - - [630]. - - . - - -
( ), - .
7.6. ( 15) -
-. 1955 . G.A. Perera [631] - 500 42% - 18%. - 5-7 .
- , - - , - - , - - [252].
4.5.4, - , - , , 120/80 . ., - . - - - - - [318,430,442]. - , ,
ALLHAT [428], - . -, - - . , - , . - , 1 / ( - 1 / ), - [632]. - -
[446,450] [451,452] . - .
7.7. ( 18)
30-44 , [633]. - , [634], 60 . - , - [635]. -, -
-
50 2008; 1-2
2007
[295]. - - -.
. ANBP 2, - [327], VALUE, - , - [636].
. - . - .
7.7.1. -
5% [637,638]. - , , - 35 , [638]. , - , , 6 . - - [639], - - , ,
[640]. -, [640]. - [641], [642]. - - [643], [644].
, 30 1 , -. , , 1994 . - , - , , - , ( 2,3/1,6 . .) [637]. -
[638].
-, - 60- , [645-647]. -
18.
1.
. - , , - .
2.
, , , -. , , , - - .
3.
- , - , , , , -. - .
4.
, , - - .
140-149/90-95 .. - ( - ). , - , - 140/90 . . 170/110 . ., -.
, , -.
, , . - , - .
- . - , . - - , .
, . - .
-
2008; 1-2 51
2007
[648], , - - , - [649]. , 2-6 - , - .
, - , - , . ( - 2-4 ) [641], - , - - .
7.7.2. -
- , . , , , , - , [652-658]. , 18 326 - [652], , - , - ( 3/3 .
.) - .
, - - -- . - . , -- [659] [660] [661,662]. , , - , - [663]. - -
- - -- [664,665]. - Cochrane , - - , -
-, , -, , - , 65 - [666]. - - [667].
7.7.3. -
, . - 15 . . , -. . , , .
[2,668]. - , - , - (140/90 . .) [669]. - , , . - , - , , -
[670-672]. , - , , . - IV ( -), V ( ), - [673]. IV , - - [674].
V[675,676]. IV , , - 0 . .
- :
, : 1-5% . - 140/90 . .
-
52 2008; 1-2
2007
20 , - 42 . .
, - . - , ( 300 / 500 / , , ++), . 20 - 42 . - .
, , - . , , - 3 / 20 -. , - .
. , -, 20 -, -. 42 . , - . , , .
60% - . - .
, - , -, - .
140-149/ 90-95 . . - [677]. , - - - . - . - , , - (2 /) [678],
[679] [680], , . - (
-
2008; 1-2 53
2007
, - , - .
- . , , - .
, , - - [690,691]. , , - , - .
7.8. ( 19)
- , . - - ( ) -
[49]. - : 1) ( 30-40%) ; 2) -- [69,692-694]; 3) - 3-6 [695,696],
[31-33,476]; 4) - --, - [697-699], [700], - , , -
[69,697,698,701-703], - [704]. - - [69,705]. [69], [69]. - , - , -
[706] - [172,707].
- [708]. 7-10% 6-12 - ( 500-1000 ), - , [709]. - , - , - - ,
[710]. - (, - 30 ) [711]. - Diabetes Prevention Program Finnishi
Diabetes Pre-vention Study [712,713] - 60%; . DPP, 3,2 - 51 43% , ,
55 61% [714]. -, - .
, -
19. - , . .
, , - - .
- -. - .
. - , . - , - . - .
- - . , - .
- . , - - .
-
54 2008; 1-2
2007
, . - -- , - [69]. - . - 4.4.5, 5.5 6.2.1, - - -, , [715], -
[716]. - -, - , [572,717]. - , [455], -. - , - - [455,458,460,718].
, (. - 4.5). - , , - - (. 4.5). , - - - - , - - [330,331]. [719], -
. - - [331,455,720], , - , - [721]. - [592,593]. , -.
-
, , - , - -- - -. -- - 5. , - , - - , -- , - - -, - . - , , . 5
, - , - 2- . - -, , [722]. 2- - , - PPR; - - [723,724]. (-) .
[725]. - - , -/ . - [726]. -, [727]. - 1- - - , - , , , -
[728-731]. - , . -- [732].
-
2008; 1-2 55
2007
, - -, - . - , 140/90 . . -- , - - . -- - - - . 2- -, - - - . ,
- [733]. - , - . , , - [734].
7.9. ( 20)
, -, , - ( ) - . , ,: , ALLHAT 8% 4 , - 15% [322]. - - , - - -
[735].
- ( 20) - ( , -). -. - .
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