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TA PARTEA a II-a

DARABONT ROXANA OANA

Universitatea de Medicina si Farmacie

Car! Davi!a" #$ita!%! Universitar de

Ur&enta B%c%resti

ANU' I( MODU' BO'I

CARDIO(A#CU'ARE

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DIA)NO#ICU' HTA

E(A'UAREA PACIENTU'UI HIPERTEN#I(

P'ANU' PRE*ENTARII

TRATMENTU' HTA

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DIA)NO#ICU' HTA

1. MASURAREA TA IN CABINET MEDICAL

2. MASURAREA AMBULATORIE AUTOMATIZATA A

TA

3. AUTOMASURAREA

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+,.

#ci$ine Riva-Rcci inventea/0

s1i&mmanmetr%! c% merc%r

$entr% m0s%rarea tensi%nii

arteria!e !a m

DIA)NO#ICU' HTA

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DIA)NO#ICU' HTA

TAs TAd

C'A#IC 2 +34 2 4

MATA

Media 536 2+57-+84 2 ,4

Media di%rna 2+84-+87 2 ,7

Media nct%rna 2 +54 2 94

AUTOMA#URARE 2 +84-+87 2 ,7

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DIA)NO#ICU' HTA

Din: Dara;nt R< si c!a;< A%tmas%rarea si mas%rarea am;%!atrie a tensi%nii arteria!e< In: P%nct si

cntra$%nct in 6i$ertensi%nea arteria!a= Dr;ant% M< crdnatr> Edit%ra UMF Car! Davi!a= 54+8>

Fi&%ra d%$a: Parati )< si c!a; +4:+5R

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E(A'UAREA HTA

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E(A'UAREA HTA

1. EVALUAREA CLINICA

2. EVALUAREA FACTORILOR DE RISC CV SI ACOMPLICATIILOR HTA

3. EVALUAREA SIGURANTEI TRATAMENTULUI

4. EVALUAREA FORMELOR SECUNDARE DEHTA

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Mancia )< si c!a;

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Mancia )< si

c!a;

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E(A'UAREA PACIENTU'UI HIPERTEN#I(

INDICE'E )RO#IME INTIMA-MEDIA CAROTIDIAN

http://www.google.ro/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=WpCZzdljFk4NcM&tbnid=QH6vZ0FoAxasZM:&ved=0CAUQjRw&url=http%3A%2F%2Fstroke.ahajournals.org%2Fcontent%2F42%2F11%2F3017%2FF1.expansion.html&ei=IxpuUYrOK--T0QWC1IHgDQ&bvm=bv.45368065,d.ZWU&psig=AFQjCNGJEzja9IGvHegwGAjA0Of3uPbVfg&ust=1366256495270045

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TRATAMENTU' HTA

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#CADEREA HTA REDUCE RI#CU'

CARDIO(A#CU'AR DO(E*I'E TRIA'-URI'OR

Tratament%! anti6i$ertensiv se ascia/a c%

red%cere de:

87-34 - a risc%!%i de accident vasc%!ar cere;ra!54-57 - a risc%!%i de in1arct de micard

74 - a risc%!%i de ins%1icienta cardiaca

5+ - a risc%!%i de mrta!itate C(

NEA' B< si c!a;

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TAs 2 +34 i TAd 2 4mmH&

TAs 2 +34 i TAd 2 ,7mmH& !a $acientii c% dia;et

/a6arat

(A'ORI'E-TINTA A'E TRATAMENTU'UI IN

HTA

GREU DE ATINS!

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Corecre "#$%$%# &e '#() r re*%##+"#%#) &e c,e or# e"e -o"#*#$ $ o(#

-c#e+(## / 0+ e- &e e-or#re re+%$%# rco$o#c "% 0+ -r$e$ c%ce" &c) o" #+#(#.

TRATAMENTU' NON-FARMACO'O)IC

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1. CU CE CLASE DE MEDICAMENTE INITIEMTRATAMENTUL5

2. MONOTERAPIE '" TERAPIE ASOCIATA

TRATAMENTU' FARMACO'O)IC

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DIURETICE DIURETICE TIAZIDICE

COMPUSI6 7#&roc$oro##& 8129 / 29 :#;#+&-#& 819:#; #+ -r# %+#c

MECANISM DE ACTIUNE6 #+7#* re*"or*# &e N "#C$ #+ %*%$ co+or "$

INDICATII6

I+ "oc#ere c% IECA:"r+#:*$oc+e $e c+$e$or &ec$c#% / eec "#+er#c< "%+ o$o"#e #+ co*#+## =>e

HTA $ 'r"+#c#

EFECTE SECUNDARE6 7#-o-o"e#e 7#-er%r#ce#e7#-erco$e"ero$e#e 7#-erc$ce#e 7#-er$#ce#e

CI:PRECAUTII6 7#-er%r#ce#e #+"%=c#e+ re+$8C$cr?2@ $:#+;< $ -c#e+## c% "#+&ro e*o$#c #+

"oc#ere c% *e*$oc+e &e e+er#e 'ec7e

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DIURETICE DIURETICE DE ANSA

COMPUSI6 %ro"e#& 82@@:#; / #+ 23 -r#e:#*%e+#& or"e#& c#& ecr#+#c

MECANISM DE ACTIUNE6 #+7#* N::C$ co

r+"-orer%$ + -or#+e "ce+&e+ +"e# He+$eINDICATII6 HTA "oc# c% -o$o#e crcer#&e ree+#e 7#&ro"$#+ "# $er+#' $ %re#c##c #+ #+"%=c#e+ re+$ "e'er

EFECTE SECUNDARE6 7#-o'o$e#e 7#-o-o"e#e7#-er%r#ce#e 7#-erc$ce#e $c$o e*o$#c

CI:PRECAUTII6 -re"#%+e rer#$ "c%7#-er%r#ce#e

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DIURETICE

DIURETICE ECONOMISITOARE DE POTASIU

COMPUSI6 "-#ro+o$co+ 8299@ :#; e-$ere+o+:r#ere+ #$or#&

MECANISM DE ACTIUNE6 +o+#"# &e rece-or# &e$&o"ero+:#+7#* -o- NH #+ TCD

INDICATII6

HTA + 7#-er$&o"ero+#"%$ -r#r

I+ "oc#ere c% ##ce #+ HTA re#e+ $re+

EFECTE SECUNDARE6 7#-er-o"e# # $e" #+"oc#ere c% IEC "% "r+#

CI:PRECAUTII6 #+"%=c#e+ re+$ 7#-er-o"e#

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IECA

COMPUSI6 c-o-r#$ e+$-r#$ 892@ :# / 2 -r#e;r#-r#$ 891@ :# / -r# %+#c; -er#+&o-r#$ 891@:# / -r# %+#c; $#"#+o-r#$ 892@ :# / -r#%+#c; o"#+o-r#$ oe+o-r#$ ec

MECANISM DE ACTIUNE6 'e# -oe+#eINDICATII6

HTA #+ e+er$

HTA c% #+"%=c#e+ crc HTA "oc# c% *o$

coro+r#+ +#e"EFECTE SECUNDARE6 ree+#e o #+ co+## &e7#-o-er%#e re+$ 7#-er-o"e#e %"e 81@19;eece $er#ce

CI:PRECAUTII6 "rc#+ "e+o *#$er$ &e rerere+$e #+"%=c#e+ re+$

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#ARTANI

Agonisti receproti angiotensina

COMPUSI6 $o"r+ 89@1@@ :#; e$#"r+ 84@@ :#; '$"r+ 8@1@:#; c+&e"r+ 81:#; #r*e"r+ 819@3@@:#;

MECANISM DE ACTIUNE6 'e# -oe+#e

INDICATII6 HTA #+ e+er$ HTA c% IC HTA "# *o$ coro+r#+ #+c##

"-ec#=ce &e +ero-roec#e $ -c#e+## c% DZEFECTE SECUNDARE6 ree+#e o #+ co+## &e7#-o-er%#e re+$ 7#-er-o"e#e

CI:PRECAUTII6 "rc#+ "e+o *#$er$ &e rere

re+$e #+"%=c#e+ re+$

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B'OCANTE A'E CANA'E'EOR DE CA'CIU

COMPUSI6 D#7#&ro-#r#+e6 +#e-#+ rer& 82@4@:#; $o-#+ 891@ :#; $erc+#-#+ 81@2@:#; e$o-#+< +o+#&ro-#r#+e6 'er-#$8@24@ :#;

MECANISM DE ACTIUNE6 *$ocre c+$e$or &e c$c#%

"# re$>re %"c%$%r## +ee&e '"c%$re

INDICATII6

HTA #+ e+er$

HTA $ 'r"+#cHTA c% #+"%=c#e+ re+$

EFECTE SECUNDARE6 7#cre er#e c#$%$*%rr# GI e&ee ce$ee:BAV 8$#e'er-#$;

CI:PRECAUTII6 ICC BAV r& IIIII

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BETA-B'OCANTE: EFECTE HIPOTEN#OARE

DEBIT CARDIAC

INHIBITIA RENINEI

INHIBITIA ALFARECEPTORILORPRESINAPTICI 6

e$#*erre +or&re+$#+e# #+ "#+-"e o+%"%$ '"ooor ce+r$

Braunwalds Heart Disease, 7thEd., Elsevier Saunders, 2005, 1002, Fig. no. 3!10

7/24/2019 HTA_II

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BETA-B'OCANTE:

COMPUSI6

Be / *$oc+e6 -ro-r+o$o$ e+o$o$ 89@1@@:#;eo-ro$o$ 89@2@@:#; *#"o-ro$o$ 891@ :#;;

Be*$oc+e c% c#%+e "oc# $$##c6 $*eo$o$82@:#; cr'e$o$ 8299@ :#;

Be*$oc+e c% '"o$#e e &e NO6+e*#'o$o$

7/24/2019 HTA_II

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BETA-B'OCANTE:

INDICATII6

HTA c% *o$ coro+r#+

HTA c% IC HTA c% FA

HTA c% 7#-er"#%$re &re+er#c:+>#ee

EFECTE SECUNDARE6 %$*%rr# e*o$#ce $ ce$e

+e"e$ec#'e "% -%#+ "e$ec#'e CI:PRECAUTII6 *rr###

7/24/2019 HTA_II

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INHIBITORII ADRENER)ICI PERIFERICI

A'FA-B'OCANTE

COMPUSI6 -ro"#+ &o>o"#+ 812@ :# / 23-r#e;

MECANISM DE ACTIUNE6 *$ocre $1rce-or#$or+ -er#ere

INDICATII6

HTA re#"e+ $ re+

HTA + #+"%=c#e+ re+$

EFECTE SECUNDARE6 7#-oe+"#%+e "e'er $ -r#&o 7#-oe+"#%+e oro"#c

CI:PRECAUTII6 *o$ crc #"c7e#c #+"%=c#e+crc

7/24/2019 HTA_II

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INHIBITORII ADRENER)ICI CENTRA'I

7/24/2019 HTA_II

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INHIBITORII ADRENER)ICI CENTRA'I

COMPUSI6 c$o+#+ e#$&o- / re# -r#eo+#+% / o -r# -e #

MECANISM DE ACTIUNE6 "#%$re $2rece-or#$or &re+er#c# ce+r$# c% #+7#*re

eere+e$or "#-#ce "#%$re $2rece-or#$or-re"#+-#c# c% "c&ere e$#*err## &e NA

INDICATII6 HTA re#"e+ $ re+ HTA +"#+&ro%$ e*o$#c:o*e#e< $e#$&o- re#+c#e &e e$ec#e #+ HTA + "rc#+

EFECTE SECUNDARE6 7TA -o"%r$ "o+o$e+:e#$&o- "& $%-%" $#e 7e-# cr %o#%++e#e 7eo$##c

CI:PRECAUTII6 oecrooc#o

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NOI TERAPII INTER(ENTIONA'E : DENER(AREA RENA'A

PREMI*E FI*IOPATO'O)ICE

Pre/entare $r1esr )rassi )%id !a a5-a Cn1erinta a #cietatii Rmane de Hi$ertensi%ne Arteria!a= B%c%resti=

+8 se$< 54+8

7/24/2019 HTA_II

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NOI TERAPII INTER(ENTIONA'E : DENER(AREA RENA'A

PREMI*E C'INICE

#$!an6nicectmia c6ir%r&ica!a asciata c%

denervare rena!a a ame!irat s%$raviet%irea

$acienti!r 6i$ertensivi N +5.. 6i$ertensiviG

#mit6@ic R H= T6m$sn E BAMA +75: +74+-+743

7/24/2019 HTA_II

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NOI TERAPII: DENER(AREA RENA'A

7/24/2019 HTA_II

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NOI TERAPII: DENER(AREA RENA'A

PRO)RAMU' #IMP'ICIT - #IMP'ICIT +

74 $acienti Minim%m 8 anti6i$ertensive Media TA !a inc!%dere: +99+4+ mmH& Re/%!tate: scadere TA c% +3+4 mmH& !a + !%na=

59+9 mmH& !a + an

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NOI TERAPII: DENER(AREA RENA'A

PRO)RAMU' #IMP'ICIT - #IMP'ICIT + EXTEN#ION +78

$acienti !a 53 !%niG

H?$ertensin= 54++>79:++-9

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NOI TERAPII: DENER(AREA RENA'A

PRO)RAMU' #IMP'ICIT - #IMP'ICIT + EXTEN#ION +78

$acienti !a 53 !%niG

?$ertensin= 54++>79:++-9

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NOI TERAPII: DENER(AREA RENA'A

PRO)RAMU' #IMP'ICIT 5

7/24/2019 HTA_II

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NOI TERAPII: DENER(AREA RENA'A

PRO)RAMU' #IMP'ICIT 8

787 $acienti Minim%m 8 anti6i$ertensive= inc!%siv %n di%retic #tdi% $rs$ectiv= r;= randmi/at c% &r%$ cntr!

!a care s-a mimat $rced%ra de denervare rena!a Re/%!tate: di1erente nesemni1icative in scaderea

TA sist!ice !a . !%ni

B6att D' si c!a;< A cntr!!ed tria! 1 rena! denervatin 1rresistant 6?$ertensin< N En&! B Med 54+3= $%; !is6ed n Marc6 5= di:+4

7/24/2019 HTA_II

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7/24/2019 HTA_II

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NOI TERAPII: #TIMU'AREA BAROREF'EXA

7/24/2019 HTA_II

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+ DIURETICE TIA*IDICE

CU CE C'A#E DE MEDICAMENTE TREBUIE

#A INITIEMEFECTUAM TRATAMENTU' HTAK

5 BETA-B'OCANTE

8 INHIBITORI DE EN*IMA DE CON(ER#IE

3 ANTA)ONI#TI AI RECEPTORI'OR DE A II

7 B'OCANTE A'E CANA'E'OR DE CA'CIU

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MANCIA )< si c!a;

7/24/2019 HTA_II

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Mancia )< si c!a;

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OCU' IN#U'EI PU#TII IN ANU' +87:

- Care s%nt ce!e cinci medicamente $e care !e-ati !%a

daca ar tre;%i sa !c%iti $e ins%!a $%stieK

-

As$irina= mr1ina= di&ita!ina= c6ininaL"

EAN BERNARD I! 1a%t %e Je v%s diseL