Dergiler / Klinik Tıp Bilimleri / 2017 / Cilt: 5 Sayı: 5

Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?

Treatment Objectives: How Much Acceptable?

Sayfa
15–17
Yayın Tarihi
2017-05-04
DOI
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⚡ TL;DR(1 Cümlede Hızlı Çıkarım)

Fakat, yeni randomize çalışmalar ve bazı meta-analizler yüksek riskli ve yaşlı kişilerde daha düşük KB değerlerini destekleyen bazı veriler ortaya koymuştur.

📌 3 Maddede Bu Makale

🎯
Amaç & Hipotez:Öz Hipertansiyon tedavisinde kan basıncı (KB) hedefleri devamlı değişmektedir.
📊
Temel Bulgular & Veri:Ko-morbiditesi olan ve daha düşük KB değerleri olan hastalarda tedavi başlanmasının faydaları net değildir.
💡
Sonuç & Katkı:Fakat, yeni randomize çalışmalar ve bazı meta-analizler yüksek riskli ve yaşlı kişilerde daha düşük KB değerlerini destekleyen bazı veriler ortaya koymuştur.
🔬Tür:Derleme
📍Kapsam:Genişletilmiş Akademik Örneklem
⚙️Değişkenler:Hipertansiyon · yaşlı hastalar · yüksek riskli hastalar

Özet

Öz Hipertansiyon tedavisinde kan basıncı (KB) hedefleri devamlı değişmektedir. Ko-morbiditesi olan ve daha düşük KB değerleri olan hastalarda tedavi başlanmasının faydaları net değildir. ESC ve ACC/AHA hipertansiyon rehberleri çoğu hipertansif hastada <140/90mmHg, yaşlılarda ise <150/90 mmHg değerleri hedef KB değerleri olarak önermekte-dir. Fakat, yeni randomize çalışmalar ve bazı meta-analizler yüksek riskli ve yaşlı kişilerde daha düşük KB değerlerini destekleyen bazı veriler ortaya koymuştur.

Abstract

Abstract Blood pressure goals in hypertension treatment alter frequently. It is not certain tostart anti-hypertensive treatment in patients with lower BP levels and co-morbidities. ESCand ACC/AHA hypertension guidelines recommended <140/90 mmHg BP levels in mosthypertensive patients and < 150/90 mmHg levels in older patients as BP target levels.However, novel randomized trials and some meta-analysis revealed some supporting dataof lower BP levels in high risk and older patients.

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Bu Makaleye Atıf Yap

Özdoğan, D. Ö. (2017). Tedavi Hedefleri: Ne Kadar Kabul Edilebilir?. Klinik Tıp Bilimleri, Cilt: 5 Sayı: 5, 15–17. https://ajindex.com/articles/1594867

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Kaynakça (2)

  1. Kaynaklar 1-Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, BirkenhägerWH, et al. Randomised double-blind comparison of placebo and ac-tive treatment for older patients with isolated systolic hypertension.The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.Lancet. 1997 Sep 13;350(9080):757-64. 2-Prevention of stroke by antihypertensive drug treatment in older per-sons with isolated systolic hypertension. Final results of the Systo-lic Hypertension in the Elderly Program (SHEP). SHEP Coopera-tive Research Group.[No authors listed] JAMA. 1991 Jun26;265(24):3255-64. 3-Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP, INDANAProject Steering Committee. INdividual Data ANalysis of Antihyper-tensive intervention J-shaped relationship between blood pressureand mortality in hypertensive patients: new insights from a meta-analy-sis of individual-patient data. Ann Intern Med. 2002;136(6):438. 4-Staessen J, Bulpitt C, Clement D, De Leeuw P, Fagard R, FletcherA, et al. Relation between mortality and treated blood pressure inelderly patients with hypertension: report of the European WorkingParty on High Blood Pressure in the Elderly. BMJ.1989;298(6687):1552. 5-Arguedas JA, Perez MI, Wright JM. Treatment blood pressure tar-gets for hypertension. Cochrane Database Syst Rev. 2009 Jul 8;(3) 6-Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr,Cutler JA, et al. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr29;362(17):1575-85 7-Sundström J, Arima H, Woodward M, Jackson R, Karmali K, Lloyd-Jones D, et al. Blood Pressure Lowering Treatment Trialists' Col-laboration. Blood pressure-lowering treatment based on cardiovas-cular risk: a meta-analysis of individual patient data. Lancet. 2014Aug 16;384(9943):591-8. 8-Ogihara T, Saruta T, Rakugi H, Matsuoka H, Shimamoto K, Shima-da K, et al. Valsartan in Elderly Isolated Systolic Hypertension StudyGroup. Hypertension. 2010 Aug;56(2):196-202. 9-Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Roc-co MV, et al. A Randomized Trial of Intensive versus Standard Blo-od-Pressure Control. SPRINT Research Group. N Engl J Med.2015;373(22):2103. 10-SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK,Snyder JK, Sink KM, Rocco MV et al. A Randomized Trial of Inten-sive versus Standard Blood-Pressure Control N Engl J Med 2015;373:2103-2116 10, 26, 2015 11-Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T et al. Effectsof intensive blood pressure lowering on cardiovascular and renal out-comes: updated systematic review and meta-analysis. Lancet.2016;387:435–443 12-Blood Pressure Targets in Subjects With Type 2 Diabetes Mellitus/Im-paired Fasting Glucose Observations From Traditional and Baye-sian Random-Effects Meta-Analyses of Randomized Trials Sripal Ban-galore, MD, MHA; Sunil Kumar, MD; Iryna Lobach, PhD; FranzH. Messerli, MD. 13-Jones DW. What should be the target blood pressure for CKD withovert proteinuria? J Hypertens. 2016 Sep;34 14-Franklin SS, Gokhale SS, Chow VH, Larson MG, Levy D, Vasan RSet al. Does low diastolic blood pressure contribute to the risk of re-current hypertensive cardiovascular disease events? The Framing-ham Heart Study. Hypertension, 2015 feb:65(2);299-305 15-Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm Met al; Task Force Members. 2013 ESH/ESC Guidelines for the ma-nagement of arterial hypertension: the Task Force for the manage-ment of arterial hypertension of the European Society of Hyperten-sion (ESH) and of the European Society of Cardiology (ESC).J Hyper-tens. 2013;31:1281–1357. 16-James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmel-farb C, Handler J et al. 2014 evidence-based guideline for the ma-nagement of high blood pressure in adults: report from the panel mem-bers appointed to the Eighth Joint National Committee (JNC 8). JAMA.2014;311:507–520
  2. Kaynaklar 1-Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, BirkenhägerWH, et al. Randomised double-blind comparison of placebo and ac-tive treatment for older patients with isolated systolic hypertension.The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.Lancet. 1997 Sep 13;350(9080):757-64. 2-Prevention of stroke by antihypertensive drug treatment in older per-sons with isolated systolic hypertension. Final results of the Systo-lic Hypertension in the Elderly Program (SHEP). SHEP Coopera-tive Research Group.[No authors listed] JAMA. 1991 Jun26;265(24):3255-64. 3-Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP, INDANAProject Steering Committee. INdividual Data ANalysis of Antihyper-tensive intervention J-shaped relationship between blood pressureand mortality in hypertensive patients: new insights from a meta-analy-sis of individual-patient data. Ann Intern Med. 2002;136(6):438. 4-Staessen J, Bulpitt C, Clement D, De Leeuw P, Fagard R, FletcherA, et al. Relation between mortality and treated blood pressure inelderly patients with hypertension: report of the European WorkingParty on High Blood Pressure in the Elderly. BMJ.1989;298(6687):1552. 5-Arguedas JA, Perez MI, Wright JM. Treatment blood pressure tar-gets for hypertension. Cochrane Database Syst Rev. 2009 Jul 8;(3) 6-Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr,Cutler JA, et al. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr29;362(17):1575-85 7-Sundström J, Arima H, Woodward M, Jackson R, Karmali K, Lloyd-Jones D, et al. Blood Pressure Lowering Treatment Trialists' Col-laboration. Blood pressure-lowering treatment based on cardiovas-cular risk: a meta-analysis of individual patient data. Lancet. 2014Aug 16;384(9943):591-8. 8-Ogihara T, Saruta T, Rakugi H, Matsuoka H, Shimamoto K, Shima-da K, et al. Valsartan in Elderly Isolated Systolic Hypertension StudyGroup. Hypertension. 2010 Aug;56(2):196-202. 9-Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Roc-co MV, et al. A Randomized Trial of Intensive versus Standard Blo-od-Pressure Control. SPRINT Research Group. N Engl J Med.2015;373(22):2103. 10-SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK,Snyder JK, Sink KM, Rocco MV et al. A Randomized Trial of Inten-sive versus Standard Blood-Pressure Control N Engl J Med 2015;373:2103-2116 10, 26, 2015 11-Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T et al. Effectsof intensive blood pressure lowering on cardiovascular and renal out-comes: updated systematic review and meta-analysis. Lancet.2016;387:435–443 12-Blood Pressure Targets in Subjects With Type 2 Diabetes Mellitus/Im-paired Fasting Glucose Observations From Traditional and Baye-sian Random-Effects Meta-Analyses of Randomized Trials Sripal Ban-galore, MD, MHA; Sunil Kumar, MD; Iryna Lobach, PhD; FranzH. Messerli, MD. 13-Jones DW. What should be the target blood pressure for CKD withovert proteinuria? J Hypertens. 2016 Sep;34 14-Franklin SS, Gokhale SS, Chow VH, Larson MG, Levy D, Vasan RSet al. Does low diastolic blood pressure contribute to the risk of re-current hypertensive cardiovascular disease events? The Framing-ham Heart Study. Hypertension, 2015 feb:65(2);299-305 15-Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm Met al; Task Force Members. 2013 ESH/ESC Guidelines for the ma-nagement of arterial hypertension: the Task Force for the manage-ment of arterial hypertension of the European Society of Hyperten-sion (ESH) and of the European Society of Cardiology (ESC).J Hyper-tens. 2013;31:1281–1357. 16-James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmel-farb C, Handler J et al. 2014 evidence-based guideline for the ma-nagement of high blood pressure in adults: report from the panel mem-bers appointed to the Eighth Joint National Committee (JNC 8). JAMA.2014;311:507–520