• 한국임상약학회지
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• 제22권4호
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• pp.330-339
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• 2012

Background : Hypertension is treated with both lifestyle modification and pharmacotherapy. The Seventh Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), published in 2003, provides a streamlined management approach to hypertension for the primary care physician. The JNC-7 is the gold standard also in Korea. According to the JNC-7, special therapeutic considerations are recommended for high-risk individuals with compelling indications. The presence of compelling indications in any given patient should be considered when selecting specific pharmacotherapy to treat hypertension. However, in patients with compelling indications, it is unknown that hepatotoxicity is caused by Calcium Channel Blocker (CCB), one of 1st anti-hypertensive drugs. Now, the CCB is the most used 1st anti-hypertensive drug in Korea Therefore, we evaluated the changes in blood liver function parameters (ALT, AST, Total bilirubin, serum albumin) for the study group. Methods : We randomly collected and retrospectively analyzed Electronic Medical Record data (n=28,788) of patients, and who took calcium channel blockers(non-dihydropyridines; diltiazem, verapamil, dihydropyridines; amlodipine, barnidipine, benidipine, clinidipine, efonidipine, felodipine, isradipine, lacidipine, lercanidipine, nicardipine, nifedipine, nimodipine), with having liver function tests (LFTs) from July 1st 2009 to June 30th 2010 at the Seoul National University Hospital in Korea. Control groups are two antihypertensive agents: RAS blockade (ARB; candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, ACE-I; cilazapril, enalapril, fosinopril, imidapril, perindopril, ramipril) and, Diuretics (loop; furosemide, torsemide, thiazide; hydrochlorothiazide[HCTZ], indapamide). Patients not having LFT results at these three standard points of time(baseline, during, medication, and after finishing medication) were excluded. The collected data were analyzed by using the SPSS (Version12.0) and Microsoft Excel (Version2007). Results : 711 patients who were treated CCB (297), RAS blockade (232) or Diuretics (182) monotherapy were selected for the study. In selected patients, liver damage degree(changes of each LFTs value) was higher in diuretics group than other groups, followed by RAS blockade and CCB. In diuretics group's was loop-diuretics group was higher than thiazide-diuretics group. In CCB group, Nondihydropyridine-CCB's damage degree was higher than Dihydropyrine-CCB's that. Conclusions : Despite the limitations due to the retrospective study, among patients with abnormal LFTs, the use of CCBs led to a less liver damage than other 1st anti-hypertensive agents. It can be recommended CCBs as one of the initial treatments of hypertension in patients with liver disease.

• Childhood Kidney Diseases
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• 제9권2호
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• pp.245-250
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• 2005

저자들은 정맥 주사용 스테로이드 충격요법과 경구 cyclophosphamide 치료를 받던 신증후군 환아에서 가역성 후백질뇌병증 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• 약학회지
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• 제45권1호
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• pp.85-92
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• 2001

Nitric oxide is a tonically produced vasodilator that maintains blood pressure in the normal animal. The chronic inhibition of nitric oxide synthase (NOS) elicits the hypertension in rats. However, the mechanism of hypertension induced by chronic inhibition of NOS is not clear. Thus, to clarify the mechanism of the occurance of hypertension, the changes in $\alpha$-adrenergic systems in rats treated with NOS inhibitors for 21 days were examined. Chronic administration of L-NAME significantly increased in the basal blood pressure, but chronic administration of 7-nitroindazole did not. Phenylephrine and G-protein stimulator elicited the more potent contraction in the aorta of the L-NAME-induced hypertensive rats. However when the contractile responses by phenylephrine and G-protein stimulator were calculated the proportion to the contraction by 25 mM KCL, there was no difference between the vehicle-treated rats and the L-NAME-treated rats. The density of $\alpha$-adrenergic receptors in aortic tissue was not changed by the chronic inhibition of NOS. These results suggest that hypertension induced by chronic inhibition of NOS is due to the inhibition of eNOS and the increased responses to the adrenergic drugs are due to the changes of the intracellular contactile mechanism of aortic tissue rather than the changes of receptor density.

• 약학회지
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• 제25권2호
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• pp.57-64
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• 1981

The antihypertensive effect of $\alpha-Methyldopa$ administered concurrently with timolol or labetalol were studied with spontaneously hypertensive rats (SHR). Every drugs were administered orally once a day after prechecking the systolic blood pressure and heart rate of SHR. The blood pressure and heart rate of SHR were significantly decreased in groups of combination while those of non-combination groups were fallen slightly. Compared with control group, the significant changes of blood pressure was obseved in group of $\alpha-methyldopa$ with timolol(100mg+2mg/kg)and $\alpha-methyldopa$ with labetalol (100mg+12.5mg/kg). The group of $\alpha-methyldopa$ with timolo 1 (100mg + 1.0mg/kg) reduced blood Pressure in similar degree as manifested in group of $\alpha-methyldopa$ with labetalol (100mg + 50mg/kg). In the group that $\alpha-methyldopa$ was administered concurrently with timolol, the maximum antihypertensive effect and heart rate decreasing effect were appeared after 3hr and 1hr of administration respectively and those effects in group of $\alpha-methyldopa$ with labetalol were appeared after 6hr of administration. The acute oral toxicity test was performed using albino mice with $\alpha-methyldopa$ alone, $\alpha-methyldopa$ with timolol (100:1) and $\alpha-methyldopa$ with labetatol (4:1), and was found that the $LD_{50}$ of $\alpha-methyldopa$ alone was 1104 mg/kg, $\alpha-methyldopa$ with timolol (100:1) was 1115 mg/kg and $\alpha-methyldopa$ with labetalol (4:1) was 354mg/kg.

• Archives of Pharmacal Research
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• 제26권6호
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• pp.499-503
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• 2003

Because physiological changes that potentially alter pharmacokinetics occurs in diabetes mellitus patients, pharamacokinetics of drugs used in the treatment of hypertension was studied using acebutolol as a model anti-hypertensive drug. Thus, the pharmacokinetics of acebutolol was investigated after oral administration of acebutolol (15 mg/kg) to control rabbits and rabbits with acute or chronic diabetes mellitus induced by alloxan. Kidney and liver functions were documented for acute and chronic diabetes mellitus groups based on plasma chemistry data. After oral administration of acebutolol to acute and chronic groups, the plasma concentrations appeared higher; As a result, area under the plasma concentration-time curve from time zero to time infinity10575 and 8668 $\mu g\cdot$ h/mL for acute and chronic group, respectively. In comparison, the area was apparently smaller in the control group (i.e., 7132 $\mu g\cdot$ h/mL). The half-life in acute groups was significantly prolonged 8.45 h compared with the half-life in the control group (i.e., 6.30 h). Alteration in acebutolol pharmacokinetics was more pronounced in the acute group as evidenced by the significantly higher values the area under the plasma concentration time curve, absorption rate constant and maximum plasma concentration compared with chronic or control group. Therefore, these observations indicate that acebutolol pharmacokinetics may be affected in patients with diabetes mellitus, especially in the early stage of the disease.

• 생약학회지
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• 제13권1호
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• pp.26-32
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• 1982

In order to investigate the effect of 'Whangryonhaedok-Tang' on the anti-inflammatory, ileum of mice, blood pressure, blood glucose, total cholesterol and antibacterial activity, those pharmacological actions were conducted. The results of this studies were summarized as follows; Rat hind paw edema induced by acetic acid was inhibited. In mice, tone of intestinal smooth muscle was suppressed with the treatment of sample and intestinal contractions induced by $BaCl_2$ was inhibited. Hypertensive effect was not observed in rabbits but was observed by the water extract of 'Whangryonhaedok-Tang' excluded Phellodendri Cortex in rabbits. The increased blood glucose levels in alloxandiabetic rabbits were significantly decreased by the oral administration of the sample I after 6 days. The total cholesterol levels in alloxan-induced rabbits were significantly decreased by the oral administration of the sample I after 9 days. Antibacterial activity was observed. In addition, we thought the pharmacological actions were significantly noted by the sample III (Methanol soluble fraction) because of the purification of effective components.

• Journal of Nutrition and Health
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• 제51권3호
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• pp.228-241
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• 2018

본 연구는 선행연구로 개발된 고혈압 관리를 위한 식생활 영양교육 프로그램의 효과를 평가하고자 서울의 3개 지역 보건소에서 50세 이상의 여성을 대상으로 영양교육 8주와 추후관리 8주로 구성된 16주간의 교육을 실시하고 정상혈압군 (71명)과 정상혈압을 초과한 고혈압군 (44명)으로 나누어 분석하였다. 교육시작 전, 8주 교육 후, 프로그램이 종료된 16주 후에 실시한 혈압 측정 및 신체계측, 혈액분석, 설문조사를 분석한 결과는 다음과 같다. 고혈압군의 혈압강하제 복용 비율은 86.4%였고 체중, BMI, 체지방비율, 허리둘레가 정상혈압군에 비해 높았다. 영양교육 8주 후 고혈압군과 정상혈압군의 수축기혈압이 감소되었고 (p < 0.05), 체중 (p < 0.001), BMI (p < 0.001), 허리둘레 (p < 0.001), 체지방비율 (p < 0.01)이 감소하였다. 혈액검사결과 고혈압군은 프로그램이 종료된 16주 후 HDL-콜레스테롤 증가 (p < 0.001)와 중성지방 감소 (p < 0.01), LDL-콜레스테롤 감소 (p < 0.05)가 나타났고, 정상혈압군도 HDL-콜레스테롤 (p < 0.001)과 중성지방 (p < 0.01)의 유의미한 변화가 나타났다. 일반식습관 총점수와 규칙적인 식습관, 균형 잡힌 식습관, 건강을 의식한 식습관의 항목 소계, 나트륨 관련 영양지식 총점이 두 군 모두 교육 후 유의적인 상승을 나타냈다 (p < 0.001). 또한 정상혈압군의 나트륨 관련 식행동 총점이 상승되었고 (p < 0.001) 고혈압군에서도 향상되는 경향을 나타냈다. 이와 부합하여 고나트륨 함유음식의 섭취빈도 총점이 교육 후 유의적으로 감소하였고 두 집단 모두 국수류, 찌개와 탕류, 김치류와 음료류의 섭취빈도가 낮아졌다. 혈압관리를 위한 자기효능감점수의 총점이 고혈압군과 정상혈압군 모두 유의적으로 상승하였는데 (p < 0.001) 특히 고혈압군은 자아효능감의 모든 문항점수가 향상되었다. 종합하면 50대 이상 여성을 대상으로 실시한 본 식생활영양교육은 혈압이 높은 군과 정상혈압군 모두에서 혈압관리 뿐만 아니라 신체계측지표 및 혈액지표에 긍정적인 변화를 유도하고 저나트륨 관련 식행동을 비롯한 일반식습관의 전반적 개선효과를 보였다. 이는 건강위험에 대한 각성, 식생활 변화를 유도할 수 있는 계기와 모니터링을 통한 실천 관리를 제공한 프로그램이 대상자의 요구에 부합한 결과로 생각된다. 본 연구는 건강위험이 높아지는 50대 이상 여성의 혈압관리 및 만성질환 예방과 식생활 관리를 위해 보건소에 기반한 지역사회 교육 프로그램의 유효한 모델을 제시한 점에 의의가 있다.

• 대한한의학회지
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• 제22권2호
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• pp.3-9
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• 2001

국내에서 많이 사용되는 한약재 51종을 극성에 따라 4가지 용매로 분획한 후 안지오텐신 전환 요소 활성도 억제를 검색한 결과 다음과 같은 결과를 얻었다. 1. 202종의 분획중 $400{\;}\mu\textrm{g}/ml$의 농도에서 안지오텐신 전환효소 활성도를 50% 이상 억제한 추출물 수는 26종이었고, 90% 이상 억제한 추출물 수는 4종이었다. 2. 대부분 추출물의 $IC_{50}$ 수치는 $300-400{\;}\mu\textrm{g}/ml$ 이었으나 택사의 물층, 황련의 buthanol, 물 추출물과 단삼의 ethylacetate, buthanol 추출물, 토사자의 ethylacetate 추출물 등은 6종의 추출물은 $200{\;}\mu\textrm{g}/ml$ 이하의 $IC_{50}$을 보였다. 이상과 같은 결과로 보아 많은 한약재들의 항고혈압 효과는 부분적으로 안지오텐신 전환효소를 억제하는 효과에 의한 것으로 여겨진다.

• Childhood Kidney Diseases
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• 제22권2호
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• pp.91-96
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• 2018

Nephrotic syndrome in the first year of life, characterized by renal dysfunction and proteinuria, is associated with a heterogeneous group of disorders. These disorders are often related to genetic mutations, but the syndrome can also be caused by a variety of other diseases. We report an infant with nephrotic syndrome associated with a neuroblastoma. A 6-month-old girl was admitted with a 10% weight loss over 10 days and nephrotic-range proteinuria. She was ill-looking, and her blood pressure was higher than normal for her age. Her cystatin-C glomerular filtration rate was decreased, and levels of plasma renin, aldosterone, and catecholamines were elevated. Renal ultrasonography and abdominal computed tomography showed a retroperitoneal prevertebral mass encasing both renal arteries and the left renal vein. The mass was partially resected laparoscopically, and the pathologic diagnosis was neuroblastoma. Findings on a simultaneous renal biopsy were unremarkable. The patient was treated with chemotherapy and several anti-hypertensive drugs, including an alpha blocker. Two months later, the mass had decreased in size and the proteinuria and hypertension were gradually improving. In an infant with abnormal renin-angiotensin system activation, severe hypertension, and nephrotic-range proteinuria, neuroblastoma can be considered in the differential diagnosis.

• 한국의료질향상학회지
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• 제3권1호
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• pp.126-143
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• 1996

Background : Little work has been carried out regarding quality assessment research in a primary care setting, comparing with that of hospitals. This study aims to evaluate the process of diagnosis and management of hypertension by public health doctors on the basis of pre-established clinical guideline, and to identify several modifying factors associated with them. Methods : Hypertension was selected as the target disease, because it is a chronic disease which is of great public health importance. Self-administered questionnaires were mailed to public health doctors practicing at health centers and health subcenters across the nation. The response rate was 20.9%. The questionnaire included the diagnosis and management process such as measuring blood pressure, history taking, physical examinations, and treatment approches and potentially modifying factors such as level of training, duration of practice as a public health doctor, and education on management of hypertension. Results : Public health doctors pay little attention in measuring BP, hypertension related history taking, performing physical examination and laboratory examination. But they devoted much effort in diagnosing hypertension exactly and giving nonpharmacological treatment. Among various antihypertensive drugs, calcium-channel blockers were the most preferred agent(50.9%). Level of training, duration of practice ad a public health doctor, and education on management of hypertension made no difference on quality of care(p>0.05). Conclusion : These public health doctors showed poor compliance with the pre-established clinical guidelines, which leaves much to be desired in diagnosing and managing hypertensive patients by public health doctors. This study might be able to contribute to develop some strategies, such as educational programs, which would be able to improve the process of care in hypertensives.