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¶§¹®¿¡ ÀÇ·á·ÀÇÇа迡¼´Â 1Â÷ÀÇ·áÀǸ¦ ´ë»óÀ¸·Î ¸¸¼ºÁúȯÀÇ ¿¹¹æ·Áø´Ü·Ä¡·á °¡À̵å¶óÀÎÀ» º¸±ÞÇÏ°í ÀÖ´Ù. ´ëÇÑÀÇÇÐȸ¿Í Áúº´°ü¸®Ã»Àº °íÇ÷¾Ð·´ç´¢º´·ÀÌ»óÁöÁúÇ÷Áõ °¢°¢ÀÇ ºÐ¾ß¿¡¼ ‘1Â÷ÀÇ·á¿ë ±Ù°Å±â¹Ý ÀÓ»óÁø·áÁöħ’À» ¸¸µé¾î ¹ßÇ¥ÇÑ ¹Ù ÀÖ´Ù. 1Â÷ÀÇ·á±â°ü¿¡¼ ¸¸¼ºÁúȯ °ü¸®ÀÇ Á߿伺ÀÌ ºÎ°¢µÊ¿¡ µû¶ó °³¿øÀǵéÀÌ Áø·á ½Ã¿¡ Âü°íÇÒ ¼ö ÀÖ´Â ÀÚ·á ¶Ç´Â µ¥ÀÌÅ͸¦ Á¦°øÇϱâ À§ÇÔÀÌ´Ù. ´ëÇÑ°íÇ÷¾ÐÇÐȸ, ´ëÇÑ´ç´¢º´ÇÐȸ, Çѱ¹ÁöÁú·µ¿¸Æ°æÈÇÐȸ µîÀÌ 1Â÷ÀÇ·á¿ë Áø·áÁöħÀÇ °³¹ß°ú °ü·ÃÇØ ÁÖ°ü ¶Ç´Â Âü¿©Ç߱⠶§¹®¿¡ °¢ ÇÐȸÀÇ °¡À̵å¶óÀΰú Å« Â÷ÀÌ´Â ¾øÀ¸³ª, Àü·«Àû °µµ(strength) ¸é¿¡¼´Â ¹Ì¼¼ÇÑ Â÷À̸¦ º¸ÀδÙ.
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°íÇ÷¾Ð ȯÀÚÀÇ °¾ÐÄ¡·á°¡ ½É³úÇ÷°üÇÕº´Áõ À§ÇèÀ» °¨¼Ò½ÃŲ´Ù´Â °ÍÀÌ ¸í¹éÇØÁö¸é¼, ¶Ç ¼öÃà±âÇ÷¾Ð 1~2mmHgÀÇ Â÷À̷εµ ½ÉÇ÷°üÁúȯ ¿¹¹æÀÇ ¼ºÆа¡ °¥¸± ¼ö ÀÖ´Ù´Â Á¡ÀÌ ½Ã»çµÇ¸é¼ Ç÷¾ÐÀº ¾ÈÀü¼±(½ÉÇ÷°üÁúȯ À§ÇèÀÌ °¡Àå ³·Àº Á¤»óÇ÷¾Ð)±îÁö ÃÖ´ëÇÑ ³·Ãç¾ß ÇÏ´Â ´ë»óÀ¸·Î ÀνĵŠ¿Ô´Ù.
Lower is better!
2010³â ÀÌÀü±îÁö¸¸ Çصµ “Ç÷¾Ð°Çϸ¦ ÃÖ´ëÇÑ ÀÌ·ï³»ÀÚ”, Áï “The lower, the better” °³³äÀÌ Æз¯´ÙÀÓÀ» Áö¹èÇß´Ù. ¸ÞŸºÐ¼®¿¡¼ ¼öÃà±âÇ÷¾Ð 115mmHg¸¦ ÃÊ°úÇÏ¸é¼ ½ÉÇ÷°üÁúȯ À§ÇèÀÌ »ó½ÂÇÏ´Â °ÍÀÌ °üÂûµÊ¿¡ µû¶ó(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 1Â÷¸ñÇ¥¿´´Ù.
ÀÌ¿¡ ±Ù°ÅÇØ ´ç½ÃÀÇ °íÇ÷¾Ð °¡À̵å¶óÀÎ ´ëºÎºÐÀº ȯÀÚ Àü¹Ý¿¡ 140/90mmHg ¹Ì¸¸ÀÇ ¸ñǥġ¸¦ 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. 2003³â ¹Ì±¹ÀÇ JNC 7Â÷ °¡À̵å¶óÀÎ, 2003·2007³â À¯·´½ÉÀåÇÐȸ(ESC)·°íÇ÷¾ÐÇÐȸ(ESH) °¡À̵å¶óÀÎ, 2004³â ´ëÇÑ°íÇ÷¾ÐÇÐȸ Áø·áÁöħ µî ´ëºÎºÐÀÇ ÀÓ»ó °¡À̵å¶óÀÎÀÌ “½ÉÇ÷°üÁúȯ °íÀ§Ç豺 °íÇ÷¾Ð ȯÀÚ´Â ¼öÃà±âÇ÷¾Ð 130mmHg ¹Ì¸¸À» ¸ñÇ¥·Î Ç÷¾ÐÀ» Á¶ÀýÇÑ´Ù”´Â Àü·«À» ¼ö¿ëÇß´Ù.
Not always better?
±×·±µ¥ ½ÉÇ÷°üÁúȯ °íÀ§Ç豺 °íÇ÷¾Ð ȯÀÚ¿¡°Ô ¾ö°ÝÇÑ Ç÷¾ÐÁ¶ÀýÀ» ¿ä±¸ÇÏ´ø Æз¯´ÙÀÓÀº ‘J-curve Hypothesis(J-°î¼± °¡¼³)’¿¡ ¹ß¸ñÀ» ÀâÈ÷°í ¸¸´Ù. J-curve´Â “¼öÃà±â, ƯÈ÷ À̿ϱâÇ÷¾ÐÀ» Á¤»óÄ¡ ¹Ì¸¸À¸·Î±îÁö °úµµÇÏ°Ô ³·Ãß¸é ¾î´À ½ÃÁ¡ºÎÅÍ ½ÉÇ÷°ü»ç°Ç ¹× »ç¸Á·üÀÌ Áõ°¡ÇÑ´Ù”´Â °¡¼³·Î, °ø°ÝÀûÀÎ Ç÷¾ÐÁ¶ÀýÀÇ À§Ç輺À» ÁöÀûÇÏ°í ÀÖ´Ù.
ÀÌ¿¡ µû¶ó 2012³â ESCÀÇ ½ÉÇ÷°üÁúȯ ¿¹¹æ °¡À̵å¶óÀκÎÅÍ ´ç´¢º´ ȯÀÚÀÇ ¸ñÇ¥Ç÷¾ÐÀ» 140/80mmHg ¹Ì¸¸À¸·Î Á¶Á¤·±Ç°íÇϱ⠽ÃÀÛÇß´Ù. ESC¿Í ESH´Â 2013³â °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.
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Wind of change
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