1. °íÇ÷¾Ð ȯÀÚ¿¡¼ °¡¸é·¹éÀÇ°íÇ÷¾Ð À¯º´·ü
‘¹éÀÇ°íÇ÷¾Ð’Àº Áø·á½ÇÇ÷¾ÐÀÌ 140/90mmHg ÀÌ»óÀÌ°í °¡Á¤Ç÷¾Ð ¶Ç´Â ÁÖ°£È°µ¿Ç÷¾ÐÀÌ 135/85mmHg ¹Ì¸¸ÀÎ °æ¿ì·Î Á¤ÀÇÇÑ´Ù. ´ëÇÑ°íÇ÷¾ÐÇÐȸÀÇ È°µ¿Ç÷¾Ð¸ð´ÏÅÍ µî·Ï»ç¾÷ ÀÚ·á¿¡ µû¸£¸é °íÇ÷¾Ð ¾à¹°Ä¡·á Áß¿¡ Áø·á½ÇÇ÷¾ÐÀÌ ³ôÀ¸³ª ÁÖ°£È°µ¿Ç÷¾ÐÀÌ Á¤»óÀΠȯÀÚÀÇ ºñÀ²Àº Àüü Ä¡·á ȯÀÚÀÇ 13.5%¿´°í, Áø·á½ÇÇ÷¾ÐÀ» ±âÁØÀ¸·Î Á¶ÀýµÇÁö ¾Ê´Â °íÇ÷¾Ð ȯÀÚÀÇ 21.3%¿´´Ù.¹
‘°¡¸é°íÇ÷¾Ð’Àº Áø·á½ÇÇ÷¾ÐÀÌ 140/90mmHg ¹Ì¸¸ÀÌ°í °¡Á¤Ç÷¾Ð ¶Ç´Â ÁÖ°£È°µ¿Ç÷¾ÐÀº °íÇ÷¾ÐÀÎ °æ¿ì·Î Á¤ÀÇÇÑ´Ù. È°µ¿Ç÷¾Ð¸ð´ÏÅÍ µî·Ï»ç¾÷ ÀÚ·á¿¡¼ ÁÖ°£È°µ¿Ç÷¾Ð 135/85mmHg¸¦ ±âÁØÀ¸·Î °íÇ÷¾ÐÀ» Áø´ÜÇϸé È°µ¿Ç÷¾Ð¸ð´ÏÅ͸¦ ½ÃÇàÇÑ È¯ÀÚÀÇ 17.6%, °íÇ÷¾Ð ¾à¹°Ä¡·á ÁßÀΠȯÀÚÀÇ 13.8%, ±×¸®°í Áø·á½ÇÇ÷¾ÐÀÌ Á¶ÀýµÇ´Â ȯÀÚÀÇ 35.1%°¡ °¡¸éÈ¿°ú¿¡ ÀÇÇØ ¿ÀÀÎµÈ Á¶ÀýµÇÁö ¾ÊÀº °íÇ÷¾ÐÀ̾ú´Ù.1
°íÇ÷¾Ð Áø´Ü¿¡ ÀÖ¾î¼ ¹éÀÇ°íÇ÷¾ÐÀ̳ª °íÇ÷¾Ð Ä¡·á Áß ¹éÀÇÈ¿°ú´Â ¿©¼º°ú ³ëÀο¡¼ ´õ ÀÚÁÖ °üÂûµÇ´Âµ¥, Á¤È®ÇÏ°Ô Áø´ÜÇÏÁö ¾ÊÀ¸¸é ºÒÇÊ¿äÇÑ ¾à¹°Ä¡·á·Î ÀÎÇÑ ºÎÀÛ¿ëÀ» À¯¹ßÇÒ ¼ö ÀÖÀ¸¹Ç·Î Áø·á½Ç ÀÚµ¿Ç÷¾Ð, °¡Á¤Ç÷¾Ð, ¶Ç´Â È°µ¿Ç÷¾ÐÀ» ÃøÁ¤ÇØ ¾à¹°Ä¡·á ½ÃÀÛ Àü¿¡ °¡±ÞÀû ¹èÁ¦ÇÏ´Â °ÍÀ» ±ÇÀåÇÑ´Ù. ¹éÀÇ°íÇ÷¾Ð ȯÀÚ¿¡°Ô´Â ´ëºÎºÐ »ýÈ°¿ä¹ýÀ» ±ÇÇÏ°í ÁÖ±âÀûÀ¸·Î Ç÷¾Ð ÃøÁ¤À» ±Ç°íÇÑ´Ù. ¾ÆÁ÷±îÁö ±Ù°Å´Â ºÒÃæºÐÇÏÁö¸¸, ¹éÀÇ°íÇ÷¾Ð ȯÀÚ°¡ ´ë»çÀÌ»óÀ» µ¿¹ÝÇϰųª ¹«Áõ»ó Àå±â¼Õ»óÀ» µ¿¹ÝÇÏ´Â °æ¿ì¿¡´Â »ýÈ°¿ä¹ý°ú µ¿½Ã¿¡ ¾à¹°Ä¡·á¸¦ °í·ÁÇÒ ¼ö ÀÖ´Ù.²
¹Ý¸é °¡¸é°íÇ÷¾ÐÀº Áö¼Ó¼º °íÇ÷¾Ðº¸´Ù ½É³úÇ÷°ü À§ÇèÀÌ ´õ ³ô´Ù´Â º¸°í°¡ ÀÖ¾î öÀúÇÑ ¾à¹°Ä¡·á°¡ °í·ÁµÈ´Ù. °¡¸é°íÇ÷¾ÐÀº Èí¿¬ÀÚ ¶Ç´Â Á÷¾÷Àû ½ºÆ®·¹½º°¡ ³ôÀº ȯÀÚ¿¡¼ ´õ ÈçÇÏ°í °íÇ÷¾ÐÀü´Ü°è ȯÀÚÀÇ 30% À̻󿡼 °üÂûµÈ´Ù.3 ƯÈ÷ À§Çèµµ°¡ ³ôÀº ´ë»çÁõÈıº, Ç¥ÀûÀå±â¼Õ»ó, ´ç´¢º´, ¸¸¼º ÄáÆϺ´, Èí¿¬ÀÚ, Á÷¾÷Àû ½ºÆ®·¹½º°¡ ³ôÀº ȯÀÚ´Â °¡¸é°íÇ÷¾ÐÀ» Áø´ÜÇØ Ä¡·áÇÏ´Â °ÍÀÌ ±ÇÀåÇÑ´Ù.
2. °¡Á¤Ç÷¾Ð°ú 24½Ã°£È°µ¿Ç÷¾ÐÀÇ ÀÓ»óÀû È¿¿ë¼º
Áø·á½Ç ¹Û(out-of-office)ÀÇ Ç÷¾ÐÀº °¡Á¤Ç÷¾Ð ¶Ç´Â È°µ¿Ç÷¾Ð¸ð´ÏÅ͸µÀ¸·Î ÃøÁ¤ÇÒ ¼ö ÀÖ´Ù. °¡Á¤Ç÷¾ÐÀ» ÃøÁ¤ÇÏ¸é °¡¸é°íÇ÷¾Ð, ¹éÀÇ°íÇ÷¾Ð°ú ÀúÇ×¼º °íÇ÷¾ÐÀ» Æò°¡ÇÏ´Â µ¥ µµ¿òÀÌ µÇ°í, °íÇ÷¾Ð ¾à¹°Ä¡·á¸¦ ¹Þ´Â ȯÀÚÀÇ Á¶Àý »óŸ¦ Á¤È®ÇÏ°Ô ¾Ë ¼ö ÀÖ´Ù. ¶ÇÇÑ È¯ÀÚÀÇ ¼øÀÀµµ, Ä¡·áÀÇ Àû±Ø¼º, ±×¸®°í Ç÷¾Ð Á¶Àý·üÀ» ³ôÀÏ ¼ö ÀÖ´Ù.
ÀϹÝÀûÀ¸·Î °¡Á¤Ç÷¾ÐÀº Áø·á½ÇÇ÷¾Ðº¸´Ù ³·´Ù. °¡Á¤Ç÷¾ÐÀ¸·Î¼ °íÇ÷¾ÐÀº 135/85mmHg ÀÌ»óÀ¸·Î Á¤ÀÇÇÑ´Ù. '°íÇ÷¾ÐÀ» Áø´ÜÇÒ ¶§ °¡Á¤Ç÷¾ÐÀº 1ÁÖÀÏ¿¡ 5ÀÏ ÀÌ»ó, ¾Æħ·Àú³áÀ¸·Î 1~3ȸ ÃøÁ¤ÇÒ °ÍÀ» ±ÇÀåÇÑ´Ù. Æò°¡ÇÒ ¶§´Â ù³¯ ÃøÁ¤Ä¡¸¦ Á¦¿ÜÇÑ ÈÄ Æò±ÕÄ¡¸¦ »ç¿ëÇÑ´Ù.
¾Æħ¿¡´Â ÀÚ°í ÀϾ¼ 1½Ã°£ À̳»¿¡, ¼Òº¯À» º» ÈÄ, °íÇ÷¾Ð¾àÀ» º¹¿ëÇϱâ Àü¿¡ ÃøÁ¤ÇÑ´Ù. Àú³á¿¡´Â ÀáÀÚ¸®¿¡ µé±â Àü¿¡ ÃøÁ¤ÇÒ °ÍÀ» ±ÇÀåÇÑ´Ù. ´Ü óÀ½ °íÇ÷¾ÐÀ» Áø´ÜÇϱâ À§Çؼ´Â 1ÁÖÀÏ µ¿¾È ¸ÅÀÏ ÃøÁ¤ÇÑ °ªÀ» »ç¿ëÇÏ´Â °ÍÀ» ±ÇÀåÇÑ´Ù.
È°µ¿Ç÷¾Ð ÃøÁ¤Àº º´¿øÀÇ ±â±â¸¦ ´ë¿©ÇØ »ç¿ëÇØ¾ß Çϸç Àß ¶§µµ Ç÷¾ÐÀÌ ÃøÁ¤µÇ¸ç ¼ö¸éÀÇ ºÒÆíÀ» ´À³¥ ¼ö ÀÖ´Ù´Â ´ÜÁ¡ÀÌ ÀÖÁö¸¸ ¹Ý´ë·Î °¡Á¤Ç÷¾Ð ÃøÁ¤À¸·Î´Â ¾òÀ» ¼ö ¾ø´Â ÁÖ°£¿¡ È°µ¿ÇÒ ¶§¿Í ¼ö¸é ÁßÀÇ Ç÷¾Ð¿¡ ´ëÇÑ Á¤º¸¸¦ Á¦°øÇÑ´Ù´Â ÀåÁ¡ÀÌ ÀÖ´Ù. º¸Åë 24½Ã°£¿¡ °ÉÃÄ 15~30ºÐ °£°ÝÀ¸·Î Ç÷¾ÐÀ» ÃøÁ¤Çϸç, Áø·á½ÇÇ÷¾Ðº¸´Ù ¿¹Èĸ¦ ´õ Àß ¹Ý¿µÇÑ´Ù.©ù
È°µ¿Ç÷¾Ð ÃøÁ¤Àº ¹éÀÇ°íÇ÷¾ÐÀÌ ÀÇ½ÉµÉ ¶§, °íÇ÷¾Ð¾à¿¡ ¹ÝÀÀÇÏÁö ¾ÊÀ» ¶§, °£ÇæÀûÀÎ °íÇ÷¾ÐÀÌ ÀÖÀ» ¶§, ÀӽŠÁß °íÇ÷¾ÐÀÇ Áø´Ü ½Ã, Ç÷¾ÐÀÌ ºÒ¾ÈÁ¤ÇÒ ¶§, ÀÚÀ²½Å°æÀå¾Ö°¡ ÀÖÀ» ¶§, À§Çèµµ Æò°¡¸¦ À§ÇØ Á¤È®ÇÑ Ç÷¾Ð ÃøÁ¤ÀÌ ¿ä±¸µÉ ¶§, Ç÷¾Ð Ä¡·á È¿°ú¸¦ Á¤È®ÇÏ°Ô ÆÇÁ¤ÇÒ ¶§ µµ¿òÀÌ µÈ´Ù.5 Ç÷¾ÐÀº ÁÖ°£¿¡ ³ô°í ¼ö¸é Áß¿¡´Â ³·¾ÆÁö´Âµ¥, Á¤»óÀûÀ¸·Î ¾ß°£Ç÷¾ÐÀº ÁÖ°£Ç÷¾Ð¿¡ ºñÇØ 10~20% ³·´Ù(dipper). ¾ß°£Ç÷¾ÐÀÌ 10% ¹Ì¸¸ °¨¼ÒÇÏ´Â °æ¿ì(non-dipper) ¶Ç´Â ¾ß°£Ç÷¾ÐÀÌ ÁÖ°£Ç÷¾Ð¿¡ ºñÇØ ¿ÀÈ÷·Á »ó½ÂÇÏ´Â °æ¿ì¿¡´Â6 ¾ß°£Ç÷¾ÐÀÌ 10% ÀÌ»ó °¨¼ÒÇÏ´Â Á¤»óÀûÀÎ °æ¿ì¿¡ ºñÇØ »ç¸Á, ½É±Ù°æ»öÁõ, ³úÁ¹Áß°ú °°Àº ½ÉÇ÷°ü»ç°Ç À§ÇèÀÌ ´õ ³ô´Ù.
¾ß°£Ç÷¾ÐÀÌ 20% ÀÌ»ó ½ÉÇÏ°Ô °¨¼ÒÇÏ´Â °æ¿ì(extreme dipper)¿¡´Â ÇãÇ÷¼º ³úÁ¹Áß°ú µ¿¸Æ°æÈÁõÀÇ À§Çèµµ°¡ Áõ°¡ÇÑ´Ù.7 ¾ß°£Ç÷¾ÐÀÌ ÁÖ°£Ç÷¾Ð¿¡ ºñÇØ ¿ÀÈ÷·Á »ó½ÂÇÏ´Â °æ¿ì(riser)¿¡´Â ´ë°³ ÀÚÀ²½Å°æÀå¾Ö°¡ ÀÖÀ¸¸ç, ÃâÇ÷¼º ³úÁ¹ÁßÀÌ ÈçÇÑ °ÍÀ¸·Î ¾Ë·ÁÁ® ÀÖ´Ù.8 ÀÌ·¸µí ÀÏÁß º¯µ¿À» ¾Ë ¼ö ÀÖ´Ù´Â °ÍÀÌ È°µ¿Ç÷¾Ð ÃøÁ¤ÀÇ ÀåÁ¡ÀÌÁö¸¸ ¹Ýº¹ ÃøÁ¤½Ã ÀÏÁß ÆÐÅÏÀÌ ÀÏ°üµÇÁö ¾Ê°í 1/3¿¡¼´Â ¾ß°£ Ç÷¾Ð °ÇÏ ¾ç»óÀÌ ¹Ù²ð ¼ö ÀÖ´Ù´Â Á¡Àº °¨¾ÈÇØ¾ß ÇÑ´Ù.
ÀÌ·¸µí °íÇ÷¾Ð ȯÀÚÀÇ Àý¹Ý À̻󿡼´Â Áø·á½Ç¿¡¼ÀÇ 1ȸ ÃøÁ¤ Ç÷¾ÐÀÌ Æò»ó½ÃÀÇ Ç÷¾ÐÀ» Àß ¹Ý¿µÇÏÁö ¸øÇϱ⠶§¹®¿¡ ÃÖ±ÙÀÇ °íÇ÷¾Ð Áø·á¿¡¼´Â °¡Á¤ Ç÷¾ÐÀ̳ª 24½Ã°£ È°µ¿Ç÷¾ÐÀ» Àû±ØÀûÀ¸·Î µµÀÔÇÏ¿© ȯÀÚÀÇ Ç÷¾Ð ¼öÁØÀ» Á¤È®È÷ ÆľÇÇϱ⸦ ±ÇÀ¯ÇÏ°í ÀÖ´Ù.
References
1. Shin J, Park SH, Kim JH, Ihm SH, Kim KI, Kim WS, et al. Discordance between ambulatory versus clinic blood pressure according to global cardiovascular risk group. The Korean journal of internal medicine. 2015;30(5):610-9. doi: 10.3904/kjim.2015.30.5.610. PubMed PMID: 26354055; PubMed Central PMCID: PMCPMC4578037.
2. Verdecchia P, Angeli F. The natural history of white-coat hypertension in the long term. Blood pressure monitoring. 2005;10(2):65-6. PubMed PMID: 15812252.
3. Wang YC, Shimbo D, Muntner P, Moran AE, Krakoff LR, Schwartz JE. Prevalence of Masked Hypertension Among US Adults With Nonelevated Clinic Blood Pressure. American journal of epidemiology. 2017;185(3):194-202. doi: 10.1093/aje/kww237. PubMed PMID: 28100465.
4. Staessen JA, Thijs L, Fagard R, O'Brien ET, Clement D, de Leeuw PW, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA : the journal of the American Medical Association. 1999;282(6):539-46. PubMed PMID: 10450715.
5. Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. The New England journal of medicine. 2006;354(22):2368-74. Epub 2006/06/02. doi: 10.1056/NEJMra060433. PubMed PMID: 16738273.
6. Kim BK, Kim YM, Lee Y, Lim YH, Shin J. A reverse dipping pattern predicts cardiovascular mortality in a clinical cohort. Journal of Korean medical science. 2013;28(10):1468-73. doi: 10.3346/jkms.2013.28.10.1468. PubMed PMID: 24133351.
7. Hamada T, Murata T, Narita K, Takahashi T, Wada Y, Kimura H, et al. The clinical significance of abnormal diurnal blood pressure variation in healthy late middle-aged and older adults. Blood pressure. 2008;17(3):134-40. Epub 2008/07/09. doi: 10.1080/08037050802162839. PubMed PMID: 18608199.
8. Profant J, Dimsdale JE. Race and diurnal blood pressure patterns. A review and meta-analysis. Hypertension. 1999;33(5):1099-104. Epub 1999/05/20. PubMed PMID: 10334794
THE MOST webmaster@mostonline.co.kr
<ÀúÀÛ±ÇÀÚ © THE MOST, ¹«´Ü ÀüÀç ¹× Àç¹èÆ÷ ±ÝÁö>