¿µ±¹ NICE °íÇ÷¾Ð Áø´Ü°ú °ü¸®
( hypertension in adults: diagnosis and Management)
NICE (National Institute for Health and Care Excellence) °¡À̵å¶óÀÎ
NICE guideline [NG136]Published date: August 2019
2019³â ¹ßÇ¥µÈ NICE °íÇ÷¾Ð °¡À̵å¶óÀÎÀº Á¦ 2 Çü ´ç´¢º´ ȯÀÚ¸¦ Æ÷ÇÔÇÏ¿© 18 ¼¼ ÀÌ»óÀÇ »ç¶÷µé¿¡¼ ÀÏÂ÷ °íÇ÷¾Ð (°íÇ÷¾Ð)À» ½Äº°ÇÏ°í Ä¡·áÇÏ´Â °ÍÀ» Æ÷ÇÔÇÕ´Ï´Ù. ÀÇ·á Àü¹®°¡°¡ °íÇ÷¾ÐÀ» Á¤È®ÇÏ°Ô Áø´ÜÇÏ°í È¿°úÀûÀ¸·Î Ä¡·áÇÒ ¼ö ÀÖµµ·ÏÇÏ¿© ½ÉÀå ¸¶ºñ ¹× ³úÁ¹Áß°ú °°Àº ½ÉÇ÷°ü ¹®Á¦ÀÇ À§ÇèÀ» ÁÙÀÌ´Â °ÍÀ» ¸ñÇ¥·Î ÇÕ´Ï´Ù
1. Ç÷¾Ð ÃøÁ¤(Measuring blood pressure)
1-1. ¸Æ¹ÚÀÌ ºÒ±ÔÄ¢ÇÑ °æ¿ì, »ó¿Ï µ¿¸Æ À§ÀÇ Á÷Á¢ ûÁøÀ» »ç¿ëÇÏ¿© ¼öµ¿À¸·Î Ç÷¾ÐÀ» ÃøÁ¤ÇϽʽÿÀ. ¸Æ¹Ú ºÒ±ÔÄ¢¼ºÀÌÀÖ´Â °æ¿ì(¿¹ : ½É¹æ ¼¼µ¿À¸·Î ÀÎÇØ) ÀÚµ¿È µÈ Ç÷¾ÐÃøÁ¤±â±¸´Â Ç÷¾ÐÀ» Á¤È®ÇÏ°Ô ÃøÁ¤ÇÏÁö ¸øÇÒ ¼ö ÀÖÀ¸¹Ç·Î Ç÷¾ÐÀ» ÃøÁ¤Çϱâ Àü¿¡ »ó¿Ï ¸Æ¹ÚÀ» ÃËÁøÇÏ´Â °ÍÀ» ±ÇÀåÇÑ´Ù.
1-2. º´¿øÀ̳ª °¡Á¤¿¡¼ Ç÷¾ÐÀ» ÃøÁ¤ ÇÒ ¶§, ȯ°æÀ» Ç¥ÁØȽÃÄÑ Á¶¿ëÇÏ°í ¾ÉÀº ÀÚ¼¼¿À ÆÈÀ» »¸°í ÁöÁöÇÏ¸é¼ Æí¾ÈÇÏ°í Æò¿ÂÇÑ È¯°æÀ» Á¦°øÇÑ´Ù. Æȸñ¿¡ ÀûÀýÇÑ Ä¿ÇÁ Å©±â¸¦ »ç¿ëÇØ¾ß ÇÑ´Ù.[2011, amended 2019]
1-3. ÀÚ¼¼¿¡ µû¸¥ Ç÷¾ÐÀÇ º¯È°¡ ÀÖ´Â »ç¶÷µéÀº Ç÷¾ÐÃøÁ¤ ½Ã¿¡ ´¯°Å³ª ȤÀº ¾É¾Æ¼ ÃøÁ¤ÇÑ´Ù.
1-4. ¼ ÀÖ´Â »óÅ¿¡¼ Ç÷¾ÐÀ» ÃøÁ¤ÇÒ °æ¿ì ÃÖ¼Ò 1ºÐÁ¤µµ´Â ±â´Ù¸° ÈÄ Ç÷¾ÐÀ» ÃøÁ¤ÇÑ´Ù. ¸¸¾à ¼ ÀÖ´Â »óÅ¿¡¼ ¼öÃà±â Ç÷¾ÐÀÌ 20 mmHgÀÌ»ó ¶³¾îÁø´Ù¸é :
- Åõ¾à »óÅ Á¡°Ë
- ¼ÀÖ´Â »óÅ¿¡¼ ÈļÓÇ÷¾Ð ƯÁ¤
- ÀÚ¼¼¿¡ µû¸¥ Ç÷¾ÐÀÇ º¯È°¡ Áö¼ÓµÈ´Ù¸é Àü¹®ÀÇ¿¡°Ô ÀÇ·Ú.
2. Ç÷¾Ð Áø´Ü(Diagnosing hypertension)
2-1. °íÇ÷¾Ð Áø´ÜÀ» °í·ÁÇÒ ¶§ ¾çÂÊ ÆÈ ¸ðµÎÀÇ Ç÷¾ÐÀ» ÃøÁ¤ÇÑ´Ù.
Æǵ¶ °ªÀÇ Â÷ÀÌ°¡ 15mmHg¸¦ ÃÊ°úÇϸé Ç÷¾Ð ÃøÁ¤À» ¹Ýº¹ÇÏ°í, µÎ ¹ø° ÃøÁ¤¿¡¼ ÆÈ °£ Æǵ¶ °ªÀÇ Â÷ÀÌ°¡ 15mmHg ÀÌ»óÀÎ °æ¿ì ´õ ³ôÀº Æǵ¶ °ªÀ¸·Î ÆÈÀÇ ÈÄ¼Ó Ç÷¾ÐÀ» ÃøÁ¤ÇØ¾ß ÇÑ´Ù [2019]
2-2. Áø·á¼Ò¿¡¼ ÃøÁ¤ ÇÑ Ç÷¾ÐÀÌ 140/90 mmHg ÀÌ»óÀÎ °æ¿ì :
- »ó´ã Áß¿¡ µÎ ¹ø° Ç÷¾ÐÀ» ÃøÁ¤ÇÏ°í
- µÎ ¹ø° ÃøÁ¤ÀÌ Ã¹ ¹ø° ÃøÁ¤°ú ´Ù¸¥ °æ¿ì ¼¼ ¹ø° ÃøÁ¤À» ¼öÇàÇÑ´Ù.
- ÀÓ»ó Ç÷¾ÐÀ¸·Î ¸¶Áö¸· µÎ ÃøÁ¤ °ª Áß ´õ ³·Àº °ªÀ» ±â·ÏÇÑ´Ù. [2019]
2-3. Áø·á¼Ò Ç÷¾ÐÀÌ 140/90 mmHg¿Í 180/120 mmHg »çÀÌ ÀÎ °æ¿ì, °íÇ÷¾Ð Áø´ÜÀ» È®ÀÎÇϱâ À§ÇØ ¿Ü·¡ Ç÷¾Ð ¸ð´ÏÅ͸µ (ambulatory blood pressure monitoring, ABPM)À» Á¦°øÇÑ´Ù. º´¿ø Ç÷¾ÐÀÌ 180/120 mmHg ÀÌ»óÀÎ »ç¶÷Àº 1.5 ÀýÀ» ÂüÁ¶ÇϽʽÿÀ. [2019]
2-4. ABPMÀÌ ºÎÀûÇÕÇϰųª ȯÀÚ°¡ À̸¦ °ßµô ¼ö¾ø´Â °æ¿ì¿¡´Â, °¡Á¤ Ç÷¾Ð ¸ð´ÏÅ͸µ (home blood pressure monitoring, HBPM)À» Á¦°øÇÏ¿© °íÇ÷¾Ð Áø´ÜÀ» ÇÑ´Ù. [2019]
2-5 °íÇ÷¾Ð Áø´ÜÀ» ±â´Ù¸®´Â µ¿¾È ´ÙÀ½À» ¼öÇàÇÑ´Ù.
- Àå±â ¼Õ»ó¿¡ ´ëÇÑ °Ë»ç (±ÇÀå 1.3.3 ÂüÁ¶)¿Í
- ½ÉÇ÷°ü À§Çè Æò°¡ µµ±¸¸¦ »ç¿ëÇÑ ½ÉÇ÷°ü À§Çè Æò°¡ (½ÉÇ÷°ü Áúȯ¿¡ °üÇÑ NICE °¡ÀÌµå ¶óÀÎÀÇ Àüü °ø½Ä À§Çè Æò°¡ ¼½¼Ç ÂüÁ¶) [2019]
3. ½ÉÇ÷°ü À§Çè°ú Ç¥Àû±â°ü ¼Õ»ó °Ë»ç(Assessing cardiovascular risk and target organ damage)
¸¸¼º ½ÅÀå ÁúȯÀÇ Á¶±â ½Äº° ¹× °ü¸®¿¡ ´ëÇÑ ÁöħÀº ¼ºÀÎÀÇ ¸¸¼º ½ÅÀå Áúȯ¿¡ ´ëÇÑ NICEÀÇ Áöħ(chronic kidney disease in adults)À» ÂüÁ¶ÇÑ´Ù.
3-1. ½ÉÇ÷°ü À§ÇèÀ» Æò°¡ÇÏ¿© °íÇ÷¾Ð ȯÀÚ¿Í ÇÔ²² ¿¹ÈÄ ¹× °Ç° °ü¸® ¿É¼Ç¿¡ ´ëÇØ ³íÀÇÇÑ´Ù (Ç÷¾Ð »ó½Â ¹× ±âŸ ¼öÁ¤ °¡´ÉÇÑ À§Çè ¿äÀÎ ¸ðµÎ).
3-2. °íÇ÷¾ÐÀ» °¡Áø ¸ðµç ´ë»óÀڵ鿡°Ô :
- ¾ËºÎ¹Î : Å©·¹¾ÆƼ´Ñ ºñÀ²À» ÃøÁ¤Çϱâ À§ÇØ ¼Òº¯ »ùÇÃÀ» º¸³» ¼Òº¯¿¡ ´Ü¹éÁúÀÌ ÀÖ´ÂÁö °Ë»çÇÏ°í ½Ã¾à ½ºÆ®¸³À» »ç¿ëÇÏ¿© Ç÷´¢¸¦ °Ë»ç.
- Ç÷¾× »ùÇÃÀ» äÃëÇÏ¿© ´çÈ Çì¸ð±Û·Îºó (HbA1C), ÀüÇØÁú, Å©·¹¾ÆƼ´Ñ, ÃßÁ¤ »ç±¸Ã¼ ¿©°úÀ², ÃÑ ÄÝ·¹½ºÅ×·Ñ ¹× HDL ÄÝ·¹½ºÅ×·ÑÀ» ÃøÁ¤
- °íÇ÷¾Ð ¸Á¸·ÁõÀÇ Á¸Àç¿¡ ´ëÇÑ °Ë»ç
3-3 12 ¸®µå ½ÉÀü°è¸¦ ½ÃÇàÇϵµ·Ï ÁغñÇϽʽÿÀ. [2019 °³Á¤]
4. °íÇ÷¾Ð Ä¡·á¿Í °ü¸®( Treating and monitoring hypertension)
ºñ¸¸ ¹× ½ÉÇ÷°ü Áúȯ ¿¹¹æ¿¡ ´ëÇÑ ÁöħÀº NICEÀÇ ºñ¸¸ ¿¹¹æ ¹× ½ÉÇ÷°ü Áúȯ ¿¹¹æ °¡À̵å¶óÀÎÀ» ÂüÁ¶ÇÑ´Ù(obesity prevention and cardiovascular disease prevention)
4-1. °Ç°ÇÑ ½ÄÀÌ ¿ä¹ý°ú ±ÔÄ¢ÀûÀÎ ¿îµ¿, ¾ËÄÚ¿Ã ¼·ÃëÁ¶Àý, Ä¿ÇÇ ¹× Ä«ÆäÀÎ Á¦ÇÑ, ³ªÆ®·ý ¼·Ãë ÁÙÀ̰ųª ´ëüÇÏ¿© ½ÄÀÌ ³ªÆ®·ý ¼·Ã븦 ³·°Ô À¯ÁöÇÏ´Â °ÍÀº Ç÷¾ÐÀ» °¨¼Ò½Ãų ¼ö ÀÖ´Ù.
4-2. »ýÈ°½À°ü°ú »ç¶÷µé ÀǽÄ, ¿îµ¿ ÆÐÅÏ¿¡ ´ëÇØ ³íÀÇÇÏ°í ¶óÀÌÇÁ ½ºÅ¸ÀÏ º¯È¸¦ ÃËÁøÇϱâ À§ÇØ ÀûÀýÇÑ Áöħ°ú ¼¸é ¶Ç´Â ½Ãû°¢ ÀڷḦ Á¦°øÇÑ´Ù.
4-3. Ç÷¾ÐÀ» ³·Ãß´Â ¹æ¹ýÀ¸·Î Ä®½·, ¸¶±×³×½· ¶Ç´Â Ä®·ý º¸ÃæÁ¦¸¦ Á¦°øÇÏÁö ¾Ê´Â´Ù
4-4. Èí¿¬ÀÚ¿¡°Ô ±Ý¿¬À» ±ÇÀ¯ÇÏ°í Á¶¾ðÀ» Á¦°øÇÏ°í, ±Ý¿¬ °³ÀÔ ¹× ¼ºñ½º ÁßÁö¿¡ ´ëÇÑ NICEÀÇ ÁöħÀ» ÂüÁ¶Çϵµ·Ï ÇÑ´Ù(See NICE's guideline on stop smoking interventions and services).
5. °íÇ÷¾Ð ¾à¹°Ä¡·á(Starting antihypertensive drug treatment)
NICE´Â °íÇ÷¾Ð Ä¡·á ¿É¼Ç¿¡ ´ëÇÑ È¯ÀÚ °áÁ¤ Áö¿ø( patient decision aid)À» Á¦°øÇÏ¿© »ç¶÷µé°ú ÀÇ·á Àü¹®°¡°¡ ´Ù¾çÇÑ À¯ÇüÀÇ Ä¡·á¿¡ ´ëÇØ ³íÀÇÇÏ°í °¢ °³Àο¡°Ô ÀûÇÕÇÑ °áÁ¤À» ³»¸± ¼ö ÀÖµµ·Ï µµ¿ÍÁØ´Ù.¾àÇ°ÀÇ °øµ¿ ÀÇ»ç °áÁ¤¿¡ ´ëÇÑ Á¶¾ðÀº Åõ¾à ÀûÁ¤È(medicines optimisation)¿¡ °üÇÑ NICE Áöħ¿¡¼ ȯÀÚÀÇ ÀÇ»ç °áÁ¤ Áö¿ø¿¡ ´ëÇÑ Á¤º¸¸¦ ÂüÁ¶Çؼ °áÁ¤ÇÑ´Ù.
Åõ¾à ÀÌÇà(medicines adherence)À» Áö¿øÇÏ°í °íÇ÷¾Ð ȯÀÚ°¡ ¾àÀ» °¡Àå È¿°úÀûÀ¸·Î »ç¿ëÇϵµ·ÏÇÏ·Á¸é ¾à Áؼö¿¡ ´ëÇÑ NICEÀÇ ÁöħÀ» ÂüÁ¶ÇÑ´Ù.
5-1. Áö¼ÓÀûÀÎ 2 ±â °íÇ÷¾Ð(stage 2 hypertension)ÀÇ ¸ðµç ¿¬·ÉÀÇ ¼ºÀο¡°Ô ¶óÀÌÇÁ ½ºÅ¸ÀÏ Á¶¾ð¿¡ µ¡ºÙ¿© Ç× °íÇ÷¾ÐÁ¦ Ä¡·á¸¦ Á¦°øÇÑ´Ù. ½É¾àÇϰųª º¹ÇÕÀûÀÎ ÀÌȯÀÌÀÖ´Â ¿¬·É´ëÀÇ »ç¶÷µé¿¡ ´ëÇØ ÀÓ»óÀûÀÎ ÆÇ´ÜÀ» ÇÑ´Ù(º¹ÇÕ¼º ÀÌȯ¿¡ ´ëÇÑ NICEÀÇ Áöħ ÂüÁ¶ multimorbidity). [2019]
5-2. 80 ¼¼ ¹Ì¸¸ÀÇ ¼ºÀο¡¼ °íÇ÷¾ÐÀÌ Áö¼ÓµÇ°í, 80 ¼¼ ¹Ì¸¸ÀÇ ¼ºÀÎÀÌ 1´Ü°è °íÇ÷¾Ð(stage 1 hypertension)°ú ¾Æ·¡ Áß Çϳª ÀÌ»óÀÌ ÇØ´çµÈ´Ù¸é Ç×°íÇ÷¾Ð¾à¹° ½ÃÀÛ¿¡ ´ëÇØ ³íÀÇÇÑ´Ù.
- Ç¥Àû ±â°ü ¼Õ»ó(target organ damage)
- ½ÉÇ÷°ü Áúȯ °ü·Ã(established cardiovascular disease)
- ½ÅÀå Áúȯ
- ´ç´¢º´
- 10 % ÀÌ»óÀÇ ½ÉÇ÷°ü ÁúȯÀÇ 10 ³â À§Çè ÃßÁ¤.
5-3. °³ÀÎÀÇ ½ÉÇ÷°ü Áúȯ À§Çè°ú Ä¡·á ¼±È£µµ¿¡ ´ëÇØ »óÀÇÇÏ°í Ç× °íÇ÷¾Ð ¾à¹° Ä¡·á¸¦ ½ÃÀÛÇϱâ Àü¿¡ À§Çè°ú ÀÌÁ¡À» ¼³¸íÇÑ´Ù. Ç× °íÇ÷¾ÐÁ¦ Ä¡·á ½ÃÀÛ ¿©ºÎ¿¡ °ü°è¾øÀÌ ¶óÀÌÇÁ ½ºÅ¸ÀÏ Á¶¾ðÀ» °è¼Ó Á¦°øÇÏ°í ¶óÀÌÇÁ ½ºÅ¸ÀÏÀ» ¹Ù²Ùµµ·Ï Áö¿øÇÑ´Ù. [2019]
5-4. 1 ±â °íÇ÷¾Ð°ú 10 % ¹Ì¸¸ÀÇ 10 ³â À§ÇèÀÌÀÖ´Â 60 ¼¼ ¹Ì¸¸ ¼ºÀÎÀ» À§ÇÑ »ýÈ° ½À°ü Á¶¾ð°ú ÇÔ²² °íÇ÷¾Ð Ä¡·áÁ¦¸¦ °í·ÁÇÑ´Ù. 10 ³âÀÇ ½ÉÇ÷°ü À§ÇèÀº ½ÉÇ÷°ü Áúȯ ¹ßº´ÀÇ È®·üÀ» °ú¼Ò Æò°¡ÇÒ ¼ö ÀÖÀ½À» ¸í½ÉÇØ¾ß ÇÑ´Ù. [2019]
5-5. Ŭ¸®´Ð Ç÷¾ÐÀÌ 150/90 mmHg ÀÌ»óÀÎ 80 ¼¼ ÀÌ»óÀÇ »ç¶÷µé¿¡°Ô´Â »ýÈ°½À°ü Á¶¾ð ¿Ü¿¡µµ Ç× °íÇ÷¾ÐÁ¦ Ä¡·á¸¦ °í·ÁÇÑ´Ù. Çã¾àÇϰųª º¹ÇÕÀûÀÎ ÀÌȯÀÌÀÖ´Â »ç¶÷µé¿¡ ´ëÇؼ´Â ÀÓ»ó Àû ÆÇ´ÜÇÏ¿© °áÁ¤ÇÑ´Ù (º¹ÇÕ¼º ÀÌȯ¿¡ ´ëÇÑ NICEÀÇ Áöħ ÂüÁ¶ : see also NICE's guideline on multimorbidity). [2019]
5-5. °íÇ÷¾ÐÀÌ ÀÖ´Â 40 ¼¼ ¹Ì¸¸ ¼ºÀÎÀÇ °æ¿ì, °íÇ÷¾ÐÀÇ 2 Â÷ ¿øÀο¡ ´ëÇÑ Àü¹®°¡ Æò°¡¿Í Ä¡·á ÇýÅðú À§Çè(treatment benefit and risks)¿¡ ´ëÇÑ Àå±â°£ ±ÕÇü(long-term balance)¿¡ ´ëÇÑ º¸´Ù ÀÚ¼¼ÇÑ Æò°¡°¡ ÇÊ¿äÇÏ´Ù.