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ACC¿Í AHA´Â “½ÉÇ÷°üÁúȯ º´·ÂÀÚ ¶Ç´Â 10³â³» ASCVD ¹ß»ýÀ§ÇèÀÌ 10% ÀÌ»óÀÎ ¼ºÀÎ °íÇ÷¾Ð ȯÀÚ¿¡¼ ¸ñÇ¥Ç÷¾ÐÀº 130/80mmHg ¹Ì¸¸À¸·Î ±Ç°íµÈ´Ù”°í ¹àÇû´Ù. Ãß°¡ÀûÀÎ ½ÉÇ÷°üÁúȯ À§ÇèÀÎÀÚ°¡ ÀÖ´Â °íÇ÷¾Ð ȯÀÚ¿¡¼µµ 130/80mmHg ¹Ì¸¸À¸·Î Á¶ÀýÇÏ´Â °ÍÀÌ Å¸´çÇÏ´Ù´Â ÀÔÀåÀÌ´Ù. ¾ç ÇÐȸ´Â °íÇ÷¾Ð ȯÀÚ Àü¹Ý¿¡¼ ´õ ³ª¾Æ°¡ ¾ÈÁ¤Çü ÇãÇ÷¼º ½ÉÀåÁúȯ, ½ÉºÎÀü À§Ç豺, ¹ÚÃâ·® °¨¼Ò ½ÉºÎÀü, ¸¸¼º ½ÅÀåÁúȯ, ³úÁ¹Áß 2Â÷¿¹¹æ, ´ç´¢º´ µî µ¿¹ÝÁúȯ ȯÀÚ±×·ì¿¡¼µµ ¸ñÇ¥Ç÷¾ÐÀ» 130/80mmHg ¹Ì¸¸À¸·Î Á¶ÀýÇϵµ·Ï ±Ç°íÇß´Ù.
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2010³â ÀÌÀü±îÁö¸¸ Çصµ Ç÷¾Ð°Çϸ¦ ÃÖ´ëÇÑ ÀÌ·ï³»ÀÚ´Â »ý°¢, Áï ‘The Lower, The Better’ °³³äÀÌ °íÇ÷¾Ð Ä¡·á¸¦ Áö¹èÇØ ¿Ô´Ù. ´ç½Ã ÀÏ·ÃÀÇ °üÂû¿¬±¸¿¡ ´ëÇÑ ¸ÞŸºÐ¼®¿¡¼ ¼öÃà±âÇ÷¾Ð 115mmHg¸¦ ÃÊ°úÇϸ鼺ÎÅÍ ½ÉÇ÷°üÁúȯ À§ÇèÀÌ »ó½ÂÇÏ´Â °ÍÀ¸·Î º¸°íµÇ¸é¼(Lancet 2002), Àӻ󿬱¸¸¦ ÅëÇØ ½ÉÇ÷°ü ÀÓ»óÇýÅÃÀÌ È®ÀÎµÈ 140mmHgÀ» »óÇѼ±À¸·Î µÎ°í Á¤»óÇ÷¾Ð(120/80mmHg)¿¡ °¡±õ°Ô ÃÖ´ëÇÑ °¾ÐÇÏ´Â °ÍÀÌ ´ë¼¼¿´´Ù.
The Lower
¶§¹®¿¡ ´ç½ÃÀÇ °íÇ÷¾Ð °¡À̵å¶óÀÎ ´ëºÎºÐÀÌ 140/90mmHg ¹Ì¸¸À» °íÇ÷¾Ð ȯÀÚ Àü¹ÝÀÇ Ç÷¾Ð ¸ñǥġ·Î Àû¿ëÇϸ鼵µ, ´ç´¢º´·½ÅÀåÁúȯ·½ÉÇ÷°üÁúȯ º´·ÂÀڵ鿡°Ô´Â 130/80mmHg ¹Ì¸¸ÀÇ º¸´Ù Àû±ØÀûÀÎ Ç÷¾Ð°Çϸ¦ ÁÖ¹®Çß´Ù. À̵é ÁúȯÀÌ µ¿¹ÝµÈ °íÇ÷¾Ð ȯÀÚÀÇ ½ÉÇ÷°ü»ç°Ç À§ÇèÀÌ ¸Å¿ì ³ôÀº ¸¸Å, Ç÷¾ÐÀ» ³·Ãß¸é ³·Ãâ¼ö·Ï ½ÉÇ÷°üÁúȯ À§Çè°¨¼ÒÀÇ ÆøÀÌ Å©´Ù´Â ‘The Lower, The Better’Á¢±Ù¹ýÀ» Àû¿ëÇÑ °ÍÀÌ´Ù. 2003³â ¹Ì±¹ JNC 7Â÷ °¡À̵å¶óÀÎ, 2003·2007³â À¯·´½ÉÀåÇÐȸ(ESC)·°íÇ÷¾ÐÇÐȸ(ESH) °¡À̵å¶óÀÎ, 2004³â ´ëÇÑ°íÇ÷¾ÐÇÐȸ Áø·áÁöħ µî °ÅÀÇ ´ëºÎºÐÀÇ ÀÓ»ó °¡À̵å¶óÀÎÀÌ À̸¦ ¼ö¿ëÇß´Ù. “½ÉÇ÷°üÁúȯ °íÀ§Ç豺 °íÇ÷¾Ð ȯÀÚ´Â ¼öÃà±âÇ÷¾Ð 130mmHg ¹Ì¸¸À» ¸ñǥġ·Î Ç÷¾ÐÀ» Á¶ÀýÇÑ´Ù”´Â °ÍÀÌ´Ù.
J-curve
±×·±µ¥ 130mmHg ±âÁؼ±¸¶Àú ¶Õ°í ³ª°¡·Á´ø °íÇ÷¾Ð Ä¡·á´Â ¿¹±âÄ¡ ¸øÇß´ø º¹º´À» ¸¸³µ´Ù. ¹Ù·Î ‘¼öÃà±â ¶Ç´Â À̿ϱâÇ÷¾ÐÀ» Áö³ªÄ¡°Ô ³·Ãß¸é ¾î´À ½ÃÁ¡ºÎÅÍ ½ÉÇ÷°ü»ç°Ç ¹× »ç¸Á·üÀÌ Áõ°¡ÇÑ´Ù’´Â ‘J-curve Hypothesis(J-°î¼± °¡¼³)’¿ÍÀÇ Á¶¿ì¿´´Ù.
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ÀÌ¿¡ µû¶ó 2012³â ¹ßÇ¥µÈ ESCÀÇ ½ÉÇ÷°üÁúȯ ¿¹¹æ °¡À̵å¶óÀκÎÅÍ ´ç´¢º´ ȯÀÚÀÇ Ç÷¾Ð ¸ñǥġ¸¦ 140/80mmHg ¹Ì¸¸À¸·Î Á¶Á¤ÇØ ±Ç°íÇϱ⠽ÃÀÛÇß°í, ½ÉÇ÷°üÁúȯ °íÀ§Ç豺ÀÇ Ç÷¾ÐÁ¶Àý °µµÀÇ º¯È°¡ ¼ö¸é À§·Î °ø½Ä ºÎ»óÇß´Ù. ESC¿Í ESH´Â 2013³âÆÇ °íÇ÷¾Ð °ü¸® °¡À̵å¶óÀο¡¼ ½ÉÇ÷°üÁúȯ À§ÇèÀÌ °æÁõ ~ ÁßÁõ¿¡ À̸£´Â Àü¹ÝÀûÀÎ °íÇ÷¾Ð ȯÀÚµéÀÇ Ç÷¾Ð ¸ñǥġ¸¦ 140/90mmHg ¹Ì¸¸À¸·Î ÅëÀϽÃÄÑ Àû¿ëÇß´Ù. ´õ Áß¿äÇÑ ´ë¸ñÀº ´ç´¢º´·½ÉÇ÷°üÁúȯ·½ÅÀåÁúȯ ȯÀÚ µî ½ÉÇ÷°ü °íÀ§Ç豺 °íÇ÷¾Ð ȯÀÚÀÇ ¼öÃà±âÇ÷¾Ð ¸ñǥġ¸¦ 130mmHg¿¡¼ 140mmHg ¹Ì¸¸À¸·Î ¿ÏÈÇØ ±Ç°íÇß´Ù´Â Á¡ÀÌ´Ù. 2013 ¹Ì±¹ °íÇ÷¾Ð °¡À̵å¶óÀÎ(JNC 8Â÷ º¸°í¼), 2014 ¹Ì±¹´ç´¢º´ÇÐȸ(ADA) °¡À̵å¶óÀÎ, 2013 ´ëÇÑ°íÇ÷¾ÐÇÐȸ °íÇ÷¾Ð Áø·áÁöħ ¸ðµÎ ½ÉÇ÷°üÁúȯ °íÀ§Ç豺 Ç÷¾ÐÁ¶Àý°ú °ü·ÃÇØ ¼öÃà±âÇ÷¾Ð 130mmHg ¹Ì¸¸ÀÇ ºÎÀ縦 ¾Ë·È´Ù.
SPRINT
ÀÌ È帧À» ´Ü¹ø¿¡ µÚÁý¾î ¹ö¸° ±Ù°Å°¡ ¹Ù·Î SPRINT ¿¬±¸´Ù. ¼öÃà±âÇ÷¾Ð 120mmHg ¹Ì¸¸ ¸ñǥġ ±×·ì(ÁýÁßÄ¡·á, Æò±Õ Ç×°íÇ÷¾ÐÁ¦ 3°³)°ú 140mmHg ¹Ì¸¸ ±×·ì(Ç¥ÁØÄ¡·á, Æò±Õ Ç×°íÇ÷¾ÐÁ¦ 2°³)À» ºñ±³ÇÑ °á°ú, ½É±Ù°æ»öÁõ·¿©Å¸ °ü»óµ¿¸ÆÁúȯ·³úÁ¹Áß·½ÉºÎÀü·½ÉÇ÷°ü ¿øÀÎ »ç¸ÁÀÇ º¹ÇÕºóµµ°¡ ¿¬°£ 1.65% ´ë 2.19%·Î ÁýÁßÁ¶Àý±ºÀÇ »ó´ëÀ§Çèµµ°¡ 25% À¯ÀÇÇÏ°Ô °¨¼ÒÇß´Ù(hazard ratio 0.75, P£¼0.001).
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