hypertension (LH Indholdsside)

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      <HtmlField Name="PageContent"><![CDATA[<h2>Diagnose</h2>
<h3>Diagnostiske kriterier</h3>
<ul>
    <li>Diagnosen hypertension
    <ul>
        <li>Foruds&aelig;tter at blodtrykket er m&aring;lt gentagne gange, helst af personen selv i dennes hjem (hjemmeblodtryk), under en observationstid med samtidige livstils&aelig;ndringer, der afh&aelig;nger af blodtryksh&oslash;jden, og som ved grad 1 (mild) hypertension kan v&aelig;re p&aring; 3-6 m&aring;neder. Ved grad 2 (moderat) hypertension b&oslash;r intervention (livstils&aelig;ndringer og blodtrykss&aelig;nkende medicin) vurderes efter kortere observationstid. Ved grad 3 (sv&aelig;r) b&oslash;r intervention (livstils&aelig;ndringer og blodtrykss&aelig;nkende medicin) vurderes under behandling. I s&aelig;rlige situationer b&oslash;r der suppleres med d&oslash;gnblodtryk</li>
        <li>Blodtrykket b&oslash;r hver gang m&aring;les 3 gange efter 5 minutters siddende hvile. Der tages gennemsnit af de sidste 2 m&aring;linger. Hvis blodtrykkene afviger mere end 5 mmHg fra hinanden tages supplerende m&aring;linger</li>
        <li>Patienten skal v&aelig;re placeret behageligt siddende i stol med rygl&aelig;n uden korslagte ben. Hos &aelig;ldre og patienter med diabetes b&oslash;r blodtrykket ogs&aring; m&aring;les i st&aring;ende stilling efter 3-5 minutter for at afsl&oslash;re ortostatisk blodtryksfald</li>
        <li>Ved f&oslash;rste m&aring;ling m&aring;les p&aring; begge arme, og ved eventuel forskel i blodtrykket foretages efterf&oslash;lgende m&aring;linger p&aring; den arm, hvor trykket er h&oslash;jst</li>
        <li>Blodtrykket skal m&aring;les med rigtig manchetst&oslash;rrelse. Patienter med tykke eller muskul&oslash;se overarme kan beh&oslash;ve stor manchet. Patienter med tynde overarme kan beh&oslash;ve lille manchet</li>
        <li>Hjemme- og/eller d&oslash;gnblodtryk b&oslash;r s&aring; vidt muligt altid anvendes i hypertensionsdiagnostikken, da:
        <ul>
            <li>20 % af patienterne har white-coat hypertension</li>
            <li>M&aring;leusikkerheden er mindre end for klinikblodtrykket</li>
            <li>De ambulante blodtryk er en bedre pr&aelig;diktor for komplikationer end konsultationsblodtrykket&nbsp;</li>
        </ul>
        </li>
        <li>Alternativt til hjemme- eller d&oslash;gnblodtryksm&aring;ling kan i klinikken anvendes uobserverede fuldautomatisk blodtryksm&aring;ling med 3-6 m&aring;linger i et roligt rum efter 5 minutters hvile og mere end 5 minutter uden tilstedev&aelig;relse af sundhedsperson</li>
    </ul>
    </li>
    <li>Totalrisiko
    <ul>
        <li>Den kliniske betydning af hypertension og dermed indikationen for behandling afh&aelig;nger af den enkeltes samlede risiko for udvikling af hjerte-kar-sygdom. Risikoen estimeres p&aring; baggrund af tilstedev&aelig;relse af risikofaktorer, hypertensive m&aring;lorganskader, anden sygdom (kardiovaskul&aelig;r sygdom, diabetes mellitus, kronisk nyresygdom) og graden af blodtryksforh&oslash;jelsen</li>
        <li>Patientens risiko for apopleksi eller myokardieinfarkt kan bed&oslash;mmes ved at anvende en tabel, der tager h&oslash;jde for hypertensive organskader og komorbiditet - se&nbsp;<a href="~/link.aspx?_id=9497D24176D74AFCB63939770E949A12&amp;_z=z">tabel</a></li>
        <li>Score2-systemet estimerer risikoen for d&oslash;d af kardiovaskul&aelig;r sygdom, apopleksi eller ikke d&oslash;delig blodprop i hjertet ud fra alder, k&oslash;n, kolesteroltal, blodtryk og rygestatus og er kalibreret til Danmark, som er et lavrisiko land mht. hjerte-kar-sygdom. Da den lave risiko i Danmark blandt andet skyldes den relativt hyppige brug af blodtryks- og lipids&aelig;nkende medicinsk behandling anbefaler <a href="https://nbv.cardio.dk/hypertension">Dansk Cardiologisk Selskab</a>, at man specielt hos de midaldrende iv&aelig;rks&aelig;tter medicinsk behandling ved en lavere risiko for hjerte-kar-sygdom&nbsp;end anbefalet i de europ&aelig;iske retningslinjer.&nbsp;Systemet tager ikke h&oslash;jde for organskade og kan kun anvendes hos patienter uden kardiovaskul&aelig;r sygdom og diabetes mellitus, se&nbsp;<a href="https://vejledninger.dsam.dk/hjerte/?mode=visKapitel&amp;cid=1062&amp;gotoChapter=1062">DSAM's vejledning for isk&aelig;misk-hjerte-kar-sygdom, risikovurdering</a></li>
        <li>Vurder om der foreligger m&aring;lorganskader - EKG, mikroalbuminuri, estimeret glomerul&aelig;r filtrationshastighed og ved mistanke om malign hypertension oftalmoskopi</li>
        <li>Kortl&aelig;g risikofaktorer - arv, rygning, motions- og kostvaner, lipidprofil, kardiovaskul&aelig;r komorbiditet, diabetes mellitus, nefropati</li>
    </ul>
    </li>
</ul>
<h4>Terminologi for grader og former af hypertension</h4>
<ul>
    <li>Baseret p&aring; hjemmeblodtryk inddeles hypertension i 3 grader:</li>
    <li>Grad 1 hypertension (mild hypertension) defineres som
    <ul>
        <li>Systolisk hjemmeblodtryk 135-154 mmHg, eller</li>
        <li>Diastolisk hjemmeblodtryk 85-94 mmHg</li>
    </ul>
    </li>
    <li>Grad 2 hypertension (moderat hypertension)
    <ul>
        <li>Systolisk hjemmeblodtryk 155-174 mmHg, eller</li>
        <li>Diastolisk hjemmeblodtryk 95-104 mmHg</li>
    </ul>
    </li>
    <li>Grad 3 hypertension (sv&aelig;r hypertension)
    <ul>
        <li>Systolisk hjemmeblodtryk 175 mmHg eller derover, eller</li>
        <li>Diastolisk hjemmeblodtryk 105 mmHg eller derover</li>
    </ul>
    </li>
    <li>Isoleret systolisk hypertension
    <ul>
        <li>Systolisk hjemmeblodtryk 135 mmHg eller derover, diastolisk hjemmeblodtryk under 85 mmHg</li>
    </ul>
    </li>
    <li>Ukompliceret hypertension: hypertension uden manifest sygdom, men evt. med tilstedev&aelig;relse af andre risikofaktorer end blodtrykket</li>
    <li>Kompliceret hypertension: hypertension med komplicerende kardiovaskul&aelig;r sygdom eller betydelig subklinisk kardiovaskul&aelig;r organskade</li>
    <li>Malign hypertension
    <ul>
        <li>Udtalt hypertension med hurtigt progredierende organp&aring;virkning</li>
    </ul>
    </li>
    <li>White coat hypertension: Blodtrykket er forh&oslash;jet hos l&aelig;gen, normalt i hjemmet</li>
    <li>White coat effekt: Et forh&oslash;jet blodtryk stiger yderligere hos l&aelig;gen</li>
    <li>Maskeret hypertension: Blodtrykket er normalt hos l&aelig;gen, forh&oslash;jet i hjemmet. Er blevet opdaget i forbindelse med d&oslash;gnblodtryksm&aring;linger</li>
</ul>
<h3>Sygehistorie</h3>
<h4>Generelt</h4>
<ul>
    <li>Vurder om patienten har symptomer p&aring; grund af selve det forh&oslash;jede blodtryk eller p&aring; grund af komplikationer til blodtrykket</li>
    <li>Kortl&aelig;g hvilken totalrisiko patienten har for hjerte-kar-sygdom, koble symptomer og fund</li>
</ul>
<h4>Symptomer og tegn forbundet med hypertension</h4>
<ul>
    <li>Hypertension giver som regel ingen symptomer undtagen ved meget h&oslash;je tryk
    <ul>
        <li>Symptomer kan v&aelig;re hovedpine, svimmelhed, funktionsdypsn&oslash;, anstrengelsesrelaterede brystsmerter eller hjertebanken</li>
        <li>Ved diastolisk blodtryk over 120 mmHg er hovedpine meget hyppig. Ofte lokaliseret til nakken. Derudover kan hypertensionspatienter ved alle blodtryksniveauer have almindelig sp&aelig;ndingshovedpine. Endelig kan patienterne have hovedpine som bivirkning til behandling med en vasodilaterende calciumantagonist</li>
    </ul>
    </li>
    <li>Tegn til sekund&aelig;r hypertension?
    <ul>
        <li>Urin-stiks for h&aelig;moglobin og protein med henblik p&aring; nyresygdom</li>
        <li>Behandlingsrefrakt&aelig;r hypertension (blodtrykket vedblivende for h&oslash;jt trods 3 eller flere l&aelig;gemidler)</li>
        <li>Betydelig stigning i s-kreatinin efter start p&aring; ACE-h&aelig;mmer eller angiotensin 2 blokker</li>
        <li>En velbehandlet hypertension bliver vanskelig at styre, is&aelig;r hos den &aelig;ldre patient (udvikling af arterioskleroisk nyrearteriestenose)</li>
        <li>Hypokali&aelig;mi, specielt uden brug af diuretika (Conn's syndrom, aldosteronproducerende binyreadenom)</li>
        <li>Anfald af hovedpine, svedtendens og takykardi (f&aelig;okromocytom)?</li>
        <li>Moderat-sv&aelig;r hypertension hos unge patienter (M&aelig;nd/kvinder yngre end 40/45 &aring;r)</li>
    </ul>
    </li>
    <li>Tegn p&aring; hjerte- eller karsygdom?
    <ul>
        <li>Mislyde? Aortasklerose? EKG</li>
    </ul>
    </li>
</ul>
<h4>Faktorer som &oslash;ger risikoen for hypertension</h4>
<ul>
    <li>Manglende motion</li>
    <li>Overv&aelig;gt</li>
    <li>S&oslash;vnapnoe</li>
    <li>Stort saltindtag</li>
    <li>H&oslash;jt alkoholforbrug</li>
    <li>Specifikke l&aelig;gemidler</li>
</ul>
<h4>Risikovurdering</h4>
<ul>
    <li>Alder</li>
    <li>K&oslash;n</li>
    <li>Arv - forekomst af hjerte-kar-sygdom i familien?
    <ul>
        <li>Forekomst af h&oslash;jt blodtryk, nyresygdom, hjerte-kar-sygdom, diabetes - fortrinsvis hos 1. gradsp&aring;r&oslash;rende</li>
    </ul>
    </li>
    <li>Totalkolesterol, jfr. supplerende unders&oslash;gelser</li>
    <li>Rygning</li>
    <li>Diabetes, jfr. supplerende unders&oslash;gelser. Der skal altid foreligge&nbsp;<a href="~/link.aspx?_id=85F60F165929493799B6AC2CC604789E&amp;_z=z">HbA1c</a></li>
    <li>M&aring;lorgan sygdom, jfr. kliniske fund<br>
    Det er v&aelig;rd at erindre, at en del mennesker f&aring;r akut myokardieinfarkt eller anden kardiovaskul&aelig;r sygdom med normale risikomark&oslash;rer. Det g&aelig;lder is&aelig;r kvinder. Disse opfattes som specielt f&oslash;lsomme for arteriosklerosefremmende faktorer, og er foresl&aring;et identificeret med CT mhp. kalkindholdet i koronararterierne. Det er for tidligt at sige, om denne strategi vil vinde indpas, idet der p&aring; nuv&aelig;rende tidspunkt ikke er reel evidens for en s&aring;dan strategi</li>
    <li>Patientens absolutte kardiovaskul&aelig;re risiko kan vurderes som lav, moderat eller h&oslash;j ud fra et simpelt skema:</li>
</ul>
<table>
    <tbody>
        <tr>
            <td style="text-align: left;">Risikofaktorer<br>
            Organp&aring;virkning<br>
            Anden sygdom</td>
            <td style="text-align: left;">&rdquo;H&oslash;jt normalt hjemmeblodtryk&rdquo;<br>
            SBT 125-134<br>
            DBT 80-84</td>
            <td style="text-align: left;">Grad 1<br>
            SBT 135-154<br>
            DBT 85-94</td>
            <td style="text-align: left;">Grad 2<br>
            SBT 155-174<br>
            DBT 95-104</td>
            <td style="text-align: left;">Grad 3<br>
            SBT &ge; 175<br>
            DBT &ge; 105</td>
        </tr>
        <tr>
            <td style="text-align: left;">Ingen</td>
            <td style="text-align: left;"><br>
            </td>
            <td style="text-align: left;">Lav risiko</td>
            <td style="text-align: left;">Middel risiko</td>
            <td style="text-align: left;">H&oslash;j risiko</td>
        </tr>
        <tr>
            <td style="text-align: left;">1-2 risikofaktorer</td>
            <td style="text-align: left;"><br>
            </td>
            <td style="text-align: left;">Middel risiko</td>
            <td style="text-align: left;">Middel risiko</td>
            <td style="text-align: left;">Meget h&oslash;j risiko</td>
        </tr>
        <tr>
            <td style="text-align: left;">&ge;3 risikofaktorer eller organp&aring;virkning</td>
            <td style="text-align: left;"><br>
            </td>
            <td style="text-align: left;">H&oslash;j risiko</td>
            <td style="text-align: left;">H&oslash;j risiko</td>
            <td style="text-align: left;">Meget h&oslash;j risiko</td>
        </tr>
        <tr>
            <td style="text-align: left;">Diabetes, nyre eller hjerte-kar-sygdom</td>
            <td style="text-align: left;">Meget h&oslash;j risiko</td>
            <td style="text-align: left;">Meget h&oslash;j risiko</td>
            <td style="text-align: left;">Meget h&oslash;j risiko</td>
            <td style="text-align: left;">Meget h&oslash;j risiko</td>
        </tr>
        <tr>
            <td colspan="5" style="text-align: left;"><strong>Tabel 1</strong>. Risikostratificering af patienter med hypertension ved beregning af absolut 10 &aring;rs risiko for apopleksi eller myokardieinfarkt: meget h&oslash;j (&gt;30 %), h&oslash;j (20-30 %), middel (15-20 %) og lav (&lt;15 %).<br>
            SBT: systolisk hjemmeblodtryk, DBT: diastolisk hjemmeblodtryk.&nbsp;<a href="http://dahs.dk/fileadmin/user_upload/2013_opdateringer/opdateringer_2014/opdateringer_2015/behandlingsvejledning_2015_juni_final.pdf">Dansk Hypertensionsselskabs behandlingsvejledning 2015</a>&nbsp;og&nbsp;<a href="https://nbv.cardio.dk/hypertension">Dansk Cardiologisk Selskabs nationale behandlingsvejledning 2024</a><br>
            Ved risikofaktorer forst&aring;s: Famili&aelig;r disposition til kardiovaskul&aelig;r sygdom - Rygning - Hyperkolesterol&aelig;mi (total kolesterol &gt; 5,0 mmol/l eller LDL kolesterol &gt; 3,0 mmol/l - H&oslash;j alder (m&aelig;nd &gt; 55 &aring;r, kvinder &gt; 65 &aring;r) - &Oslash;get abdominalomfang (m&aelig;nd &gt;_ 102 cm, kvinder &gt;_ 88 cm) Ved organp&aring;virkning forst&aring;s: - Forh&oslash;jet s-kreatinin - Nedsat kreatininclearance &lt; 60 ml/min - Venstre ventrikel hypertrofi bed&oslash;mt ved ekg eller ekkokardiografi - Mikroalbuminuri 3,4-34 mg/mmol albumin/kreatinin i morgen spoturin Ved hjerte-kar-sygdom forst&aring;s: Cerebrovaskul&aelig;r sygdom, isk&aelig;misk hjertesygdom, kongestiv hjerteinsufficiens, perifer vaskul&aelig;r sygdom eller fremskreden retinopati (fundus hypertonicus III-IV)</td>
        </tr>
    </tbody>
</table>
<h4>Score2</h4>
<ul>
    <li>Programmet Score2 tillader estimering af risikoen for kardiovaskul&aelig;r d&oslash;d, apopleksi eller ikke d&oslash;delig blodprop i hjertet ved frav&aelig;r af kardiovaskul&aelig;r sygdom og er blevet kalibreret til incidensen af kardiovaskul&aelig;r d&oslash;d i Danmark. Se&nbsp;<a href="https://vejledninger.dsam.dk/hjerte/?mode=visKapitel&amp;cid=1062&amp;gotoChapter=1062">DSAM's vejledning for isk&aelig;misk-hjerte-kar-sygdom, risikovurdering</a></li>
</ul>
<h3>Kliniske fund</h3>
<ul>
    <li>N&oslash;jagtig blodtryksm&aring;ling - se&nbsp;<a href="~/link.aspx?_id=082222E79C8F4360921FD7EBFC1AF93E&amp;_z=z">h&oslash;jt blodtryk</a></li>
    <li>M&aring;l tre gange hver gang, og brug gennemsnittet af de to sidste m&aring;linger</li>
    <li>Hjemmeblodtryk b&oslash;r anvendes</li>
</ul>
<h4>Hvilken blodtryksmetode?</h4>
<ul>
    <li>Forskellige apparater<a href="EditorPage.aspx?da=core&amp;id=%7B9F347DAC-32D6-4CF3-9637-4F9DF6892F09%7D&amp;ed=FIELD417681738&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H417682856&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" title="Messerli FH, Williams B, Ritz E, Essential hypertension. Lancet 2007;370: 591-603" data-url="reference-link" data-value="Messerli FH, Williams B, Ritz E, Essential hypertension. Lancet 2007;370: 591-603" data-type="journal-reference" data-value-piped="Messerli FH, Williams B, Ritz E|Essential hypertension|Lancet|2007|370|591-603"><sup>1</sup></a><sup>,</sup><a href="http://www.dahs.dk/" title="Bang LE, Christensen KL, Hansen KW, Skov K, Wiinberg N: Diagnostisk blodtryksmåling - på døgnbasis, hjemme og i konsultationen. Dansk Hypertensionsselskab 2006. www.dahs.dk" data-url="http://www.dahs.dk" data-value="Bang LE, Christensen KL, Hansen KW, Skov K, Wiinberg N: Diagnostisk blodtryksmåling - på døgnbasis, hjemme og i konsultationen. Dansk Hypertensionsselskab 2006. www.dahs.dk" data-type="other-reference"><sup>2</sup></a>
    <ul>
        <li>Kviks&oslash;lvmanometret angives at have den bedste n&oslash;jagtighed, men EU har forbudt brug af kviks&oslash;lv, hvilket har f&oslash;rt til at kviks&oslash;lvmanometre ikke l&aelig;ngere benyttes klinisk. Aneroide blodtryksapparater bruger et viserinstrument i stedet for kviks&oslash;lvs&oslash;jlen. Det b&oslash;r blive kalibreret 1 gang &aring;rligt. Elektroniske apparater anvender oftest oscillometrisk metode, hvor tryksvingninger i manchetten omregnes til systolisk og diastolisk blodtryk. B&oslash;r kalibreres 1 gang &aring;rligt.&nbsp;Det b&oslash;r&nbsp;ikke anvendes ved v&aelig;sentlig hjertearytmi. Oscillometriske apparater, der m&aring;ler blodtrykket ved h&aring;ndleddet frar&aring;des generelt, da der vil ske fejlm&aring;ling, hvis patienten ikke overholder at holde h&aring;ndleddet i hjerteh&oslash;jde. Kun <a href="~/link.aspx?_id=F2FDE9B1A5E84C3C9893FF6A8ADAC1DB&amp;_z=z">validerede</a>&nbsp;aneroidmanometer og elektroniske apparater b&oslash;r anvendes. Hjemmeblodtryksm&aring;linger giver blodtryksv&aelig;rdier, som korrelerer bedre med m&aring;lorganskader end konsultationsm&aring;linger ("<a href="http://www.dahs.dk/fileadmin/user_upload/2013_opdateringer/opdateringer_2014/Hypertensionsdiagnostik_2013__opdatering_fra_Dahs._2013.pdf">Hypertensionsdiagnostik 2013 &ndash; opdatering fra Dansk Hypertensionsselskab</a>")</li>
    </ul>
    </li>
    <li>Klinikblodtryksm&aring;ling
    <ul>
        <li>Anbefales prim&aelig;rt kun ved screening</li>
        <li>White coat-hypertension betegner, at blodtrykket er forh&oslash;jet hos l&aelig;gen, men normalt i hjemmet. Disse patienter synes ikke at have fordel af behandling, s&aring;fremt der ikke&nbsp;samtidig er&nbsp;subklinisk organskade</li>
        <li>White coat-hypertension kan forudg&aring; udvikling af hypertension. Dog synes egenskaben "white coat hypertension" at have en additiv effekt p&aring; kardiovaskul&aelig;r risiko&nbsp;<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
        <li>White coat effekt p&aring; blodtrykket kan ses hos patienter, der ogs&aring; har hypertension ved hjemmem&aring;linger, men stadig betydeligt h&oslash;jere v&aelig;rdier hos l&aelig;gen</li>
        <li>Til diagnostik af hypertension kan alternativt til hjemme- eller d&oslash;gnblodtryk i klinikken foretages fuldautomatisk blodtryksm&aring;ling med 3-6 m&aring;linger i et roligt rum efter 5 minutters hvile og over 5 minutter uden tilstedev&aelig;relse af sundhedsperson</li>
    </ul>
    </li>
    <li>D&oslash;gnblodtryksm&aring;ling og hjemmeblodtryksm&aring;ling
    <ul>
        <li>D&oslash;gnblodtryksm&aring;ling indeb&aelig;rer automatiserede m&aring;linger af brachial-arterie-trykket over en 24 timers periode, mens patienten udf&oslash;rer daglige aktiviteter</li>
        <li><a rel="noopener noreferrer" href="https://www.dsam.dk/vejledninger/hjemmeblodtryksmaling" target="_blank">Hjemmeblodtryksm&aring;ling&nbsp;</a>udf&oslash;res af patienten selv eller et familiemedlem (<a rel="noopener noreferrer" href="https://www.dsam.dk/vejledninger/hjemmeblodtryksmaling/hjemmeblodtryksmaling-i-almen-praksis#indikation-for-hjemmeblodtryksmaaling" target="_blank">skema til hjemmeblodtryksm&aring;ling</a>)</li>
        <li>Hjemmem&aring;linger b&oslash;r altid foretages ved hypertensionsudredning. Hjemmem&aring;linger giver generelt lavere v&aelig;rdier end klinikm&aring;linger. De synes at v&aelig;re bedre prognostiske indikatorer for de kardiovaskul&aelig;re komplikationer til hypertension</li>
        <li>Metoden anbefales af s&aring;vel det europ&aelig;iske som det danske hypertensionsselskab og kardiologiske selskab. De britiske NICE-guidelines anbefaler, at hypertensionsdiagnosen altid skal bekr&aelig;ftes ved m&aring;linger i dagtidsdelen af d&oslash;gnblodtrykket<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
        <li>D&oslash;gnblodtryksm&aring;ling har vist at v&aelig;re bedre pr&aelig;diktor for kardiovaskul&aelig;r korttidsrisiko end konventionel blodtryksm&aring;ling ved isoleret systolisk hypertension hos &aelig;ldre</li>
        <li>Natblodtrykket bestemt under d&oslash;gnblodtryksm&aring;ling er i en ny metaanalyse vist at v&aelig;re en st&aelig;rkere pr&aelig;diktor for kardiovaskul&aelig;re komplikationer end dagtidsblodtrykket</li>
        <li>Brug af egenm&aring;linger, ogs&aring; i kontrollen af hypertension, synes at give bedre efterlevelse af behandlingen, fordi patienten p&aring; denne m&aring;de involveres mere</li>
    </ul>
    </li>
    <li>Klinikblodtryk versus ambulant d&oslash;gnblodtryk
    <ul>
        <li>En norsk studie viste til dels store afvigelser mellem de to m&aring;lemetoder</li>
        <li>Internationalt konkluderes det, at den pr&aelig;diktive v&aelig;rdi er betydeligt h&oslash;jere for det ambulante d&oslash;gnblodtryk end for det traditionelle klinikblodtryk</li>
    </ul>
    </li>
    <li>Maskeret hypertension?<br>
    <ul>
        <li>Er defineret som h&oslash;jt blodtryk hos patienter, som ikke opfanges ved blodtryksm&aring;lingerne hos l&aelig;gen</li>
        <li>Vores viden om tilstanden er forel&oslash;big begr&aelig;nset, men den har en alvorligere prognose end white coat hypertension</li>
        <li>Patienterne f&aring;r m&aring;lt normalt tryk ved l&aelig;gekontrol men har forh&oslash;jet blodtryk ved hjemme- eller d&oslash;gnm&aring;ling</li>
        <li>I mods&aelig;tning til white coat hypertension er dette en patientgruppe, som underbehandles. Dilemmaet er, hvordan disse patienter skal identificeres</li>
        <li>Formentlig skal l&aelig;gen f&aring; foretaget hjemme- eller d&oslash;gnblodtryksm&aring;ling hos patienter med tegn p&aring; hypertensiv organp&aring;virkning eller andre kardiovaskul&aelig;re risikofaktorer p&aring; trods af normalt klinikblodtryk.</li>
    </ul>
    </li>
</ul>
<h4>Tegn p&aring; m&aring;lorganskade og sygdom?</h4>
<ul>
    <li>Hjerte
    <ul>
        <li>Venstre ventrikelhypertrofi?
        <ul>
            <li>Hvis R<sub>maks</sub>&nbsp;+ S<sub>maks</sub>&nbsp;&gt; 3,5 mV eller (RaVL+SV3+8 (for kvinder)) * QRS (varighed) &gt;2440 mV*ms)</li>
            <li>Dog er validiteten af&nbsp;EKG til at bed&oslash;mme venstre ventrikelhypertrofi ikke god</li>
        </ul>
        </li>
        <li>Angina pectoris eller gennemg&aring;et hjerteinfarkt?</li>
        <li>Hjertesvigt?</li>
    </ul>
    </li>
    <li>Blodkar
    <ul>
        <li>Perifer puls - tegn til arteriosklerose?</li>
        <li>TIA?</li>
        <li>Apopleksi?</li>
    </ul>
    </li>
    <li>Oftalmoskopi - tegn til retinopati?
    <ul>
        <li>Dog viser et systematisk studie, at rutinem&aelig;ssig fundoskopi er af lille v&aelig;rdi i opf&oslash;lgningen af patienterne</li>
    </ul>
    </li>
    <li>Nyrer - albuminuri eller mikroalbuminuri? Kreatininforh&oslash;jelse? Jfr. supplerende unders&oslash;gelser</li>
</ul>
<h3>Supplerende unders&oslash;gelser i almen praksis</h3>
<h4>Andre m&aring;linger</h4>
<ul>
    <li><a href="~/link.aspx?_id=0C63B45675614C299167D5E724DD64B0&amp;_z=z">BMI</a>&nbsp;eller hofte/talje-ratio</li>
</ul>
<h4>Blodpr&oslash;ver</h4>
<ul>
    <li>Elektrolytter, kreatinin, urinunders&oslash;gelse inkl. mikroalbuminuri - tegn p&aring; sekund&aelig;r hypertension?</li>
    <li>Urinsyre - nyttig information ved medikamentvalg</li>
    <li>Lipidprofil</li>
    <li><a href="~/link.aspx?_id=85F60F165929493799B6AC2CC604789E&amp;_z=z">HbA1c</a></li>
</ul>
<h4>EKG</h4>
<ul>
    <li>Se efter tegn p&aring; venstre ventrikel hypertrofi eller infarktf&oslash;lger
    <ul>
        <li>Venstre ventrikelhypertrofi fordobler risikoen for hjerteinfarkt, pludselig d&oslash;d og apopleksi, og firedobler risikoen for udvikling af hjertesvigt</li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=9E59981801844EC8A5D3816BA2263A7A&amp;_z=z">EKG - tjekliste</a></li>
</ul>
<h3>Andre unders&oslash;gelser hos specialist eller p&aring; sygehus</h3>
<ul>
    <li>Ultralyd evt. med Doppler af nyrearterier, isotoprenografi evt. med captopril-test ved mistanke om sekund&aelig;r renovaskul&aelig;r hypertension
    <ul>
        <li>Spiral-CT af nyrearterier, MR-angiografi eller konventionel angiografi kan bekr&aelig;fte diagnosen</li>
    </ul>
    </li>
    <li>Katekolaminer i 24t urin eller metanefriner i veneblod, ved mistanke om f&aelig;okromocytom. Ved positive fund, CT af binyrer eller binyrescintigrafi. Kortisol-m&aring;linger og CT af binyrer ved mistanke om mb. Cushing</li>
    <li>Ekkokardiografi
    <ul>
        <li>Er en mere sensitiv metode end EKG til at vurdere venstre ventrikel hypertrofi</li>
        <li>Brug af ekkokardiografi hos hypertonikere vil b&aring;de kunne afsl&oslash;re subklinisk hjertesygdom og give hj&aelig;lp til korrekt risikovurdering, diagnose og behandling af hypertonikere med hjertesygdom. Der er dog ikke klinisk evidens for at ekkokardiografi hos asymptomatiske hypertonikere reducere udviklingen af hjerte-kar-sygdom</li>
        <li>Unders&oslash;gelsen udf&oslash;res p&aring; kardiologiske afdelinger, hos praktiserende kardiologer og p&aring; nogle l&aelig;gelaboratorier</li>
    </ul>
    </li>
</ul>
<h3>Differentialdiagnoser</h3>
<ul>
    <li>White coat hypertension: Ved hypertension uden organp&aring;virkning gennemf&oslash;res hjemmeblodtryksm&aring;ling eller d&oslash;gnblodtryksm&aring;ling</li>
</ul>
<h2>Behandling</h2>
<h3>Behandlingsm&aring;l</h3>
<ul>
    <li>Reducere totalrisiko for hjerte-kar-sygdom samt d&oslash;d uden, at behandlingen reducerer patientens velbefindende og livskvalitet</li>
    <li>Behandlingsm&aring;let er generelt et hjemmeblodtryk p&aring; 120-135/70-85. Hos &aelig;ldre patienter (&gt;80 &aring;r) med overvejende systolisk hypertension er behandlingsm&aring;let et systolisk hjemmeblodtryk p&aring; 130-145 mmHg</li>
    <li>Behandlingsm&aring;l hos diabetikere (type 1 og 2) er hjemmeblodtryk p&aring;&nbsp;120-130/70-80 mmHg, hvis dette forventes muligt uden betydelige komplikationer&nbsp;<a href="http://www.dahs.dk/fileadmin/user_upload/2013_opdateringer/opdateringer_2014/opdateringer_2015/behandlingsvejledning_2015_juni_final.pdf" data-type="other-reference" data-value=" DaHS Guidelines 2015: Hypertensio arterialis - behandlingsvejledning (www.dahs.dk)" data-url="http://www.dahs.dk/fileadmin/user_upload/2013_opdateringer/opdateringer_2014/opdateringer_2015/behandlingsvejledning_2015_juni_final.pdf" title=" DaHS Guidelines 2015: Hypertensio arterialis - behandlingsvejledning (www.dahs.dk)"><sup>4</sup></a></li>
    <li>Behandlingsm&aring;l ved kronisk nefropati er hjemmeblodtryk p&aring; 120-130/70-80 mmHg, hvis dette forventes muligt uden betydelige komplikationer&nbsp;<a href="http://www.dahs.dk/fileadmin/user_upload/2013_opdateringer/opdateringer_2014/opdateringer_2015/behandlingsvejledning_2015_juni_final.pdf" data-type="other-reference" data-value=" DaHS Guidelines 2015: Hypertensio arterialis - behandlingsvejledning (www.dahs.dk)" data-url="http://www.dahs.dk/fileadmin/user_upload/2013_opdateringer/opdateringer_2014/opdateringer_2015/behandlingsvejledning_2015_juni_final.pdf" title=" DaHS Guidelines 2015: Hypertensio arterialis - behandlingsvejledning (www.dahs.dk)"><sup>4</sup></a></li>
    <li>De fleste placebokontrollerede kliniske studier af blodtryksbehandling, hvor der er vist effekt p&aring; h&aring;rde endepunkter, havde et klinikblodtryk&nbsp;p&aring; 150/90 mmHg som behandlingsm&aring;l</li>
    <li>Medicinsk behandling af mild hypertension er underst&oslash;ttet af to nyere studier samt flere metaanalyser<a href="EditorPage.aspx?da=core&amp;id=%7B9F347DAC-32D6-4CF3-9637-4F9DF6892F09%7D&amp;ed=FIELD13071665019&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H13071665408&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Lonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, Diaz R, Xavier D, Sliwa K, Dans A, Avezum A, Piegas LS, Keltai K, Keltai M, Chazova I, Peters RJ, Held C, Yusoff K, Lewis BS, Jansky P, Parkhomenko A, Khunti K, Toff WD, Reid CM, Varigos J, Leiter LA, Molina DI, McKelvie R, Pogue J, Wilkinson J, Jung H, Dagenais G, Yusuf S, HOPE-3 Investigators., Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med 2016;374: 2009-20" data-value-piped="Lonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, Diaz R, Xavier D, Sliwa K, Dans A, Avezum A, Piegas LS, Keltai K, Keltai M, Chazova I, Peters RJ, Held C, Yusoff K, Lewis BS, Jansky P, Parkhomenko A, Khunti K, Toff WD, Reid CM, Varigos J, Leiter LA, Molina DI, McKelvie R, Pogue J, Wilkinson J, Jung H, Dagenais G, Yusuf S, HOPE-3 Investigators.|Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease.|N Engl J Med|2016|374|2009-20|27041480" data-url="reference-link" data-pubmedid="27041480" title="Lonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, Diaz R, Xavier D, Sliwa K, Dans A, Avezum A, Piegas LS, Keltai K, Keltai M, Chazova I, Peters RJ, Held C, Yusoff K, Lewis BS, Jansky P, Parkhomenko A, Khunti K, Toff WD, Reid CM, Varigos J, Leiter LA, Molina DI, McKelvie R, Pogue J, Wilkinson J, Jung H, Dagenais G, Yusuf S, HOPE-3 Investigators., Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med 2016;374: 2009-20"><sup>5</sup></a><sup>,</sup><a href="EditorPage.aspx?da=core&amp;id=%7B9F347DAC-32D6-4CF3-9637-4F9DF6892F09%7D&amp;ed=FIELD13071665019&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H13071665408&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K, Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.. Lancet 2016;387: 957-967" data-value-piped="Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K|Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.|Lancet|2016|387|957-967|26724178" data-url="reference-link" data-pubmedid="26724178" title="Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K, Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.. Lancet 2016;387: 957-967"><sup>6</sup></a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Blood Pressure Lowering Treatment Trialists' Collaboration, Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet 2021;398: 1053-1064" data-value-piped="Blood Pressure Lowering Treatment Trialists' Collaboration|Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis.|Lancet|2021|398|1053-1064|34461040" data-url="reference-link" data-pubmedid="34461040" title="Blood Pressure Lowering Treatment Trialists' Collaboration, Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet 2021;398: 1053-1064"><sup>7</sup></a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Blood Pressure Lowering Treatment Trialists' Collaboration, Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021;397: 1625-1636" data-value-piped="Blood Pressure Lowering Treatment Trialists' Collaboration|Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis.|Lancet|2021|397|1625-1636|33933205" data-url="reference-link" data-pubmedid="33933205" title="Blood Pressure Lowering Treatment Trialists' Collaboration, Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021;397: 1625-1636"><sup>8</sup></a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Nazarzadeh M, Bidel Z, Canoy D, Copland E, Bennett DA, Dehghan A, Davey Smith G, Holman RR, Woodward M, Gupta A, Adler AI, Wamil M, Sattar N, Cushman WC, McManus RJ, Teo K, Davis BR, Chalmers J, Pepine CJ, Rahimi K, Blood Pressure Lowering Treatment Trialists' Collaboration, Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis. Lancet Diabetes Endocrinol 2022;10: 645-654" data-value-piped="Nazarzadeh M, Bidel Z, Canoy D, Copland E, Bennett DA, Dehghan A, Davey Smith G, Holman RR, Woodward M, Gupta A, Adler AI, Wamil M, Sattar N, Cushman WC, McManus RJ, Teo K, Davis BR, Chalmers J, Pepine CJ, Rahimi K, Blood Pressure Lowering Treatment Trialists' Collaboration|Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis.|Lancet Diabetes Endocrinol|2022|10|645-654|35878651" data-url="reference-link" data-pubmedid="35878651" title="Nazarzadeh M, Bidel Z, Canoy D, Copland E, Bennett DA, Dehghan A, Davey Smith G, Holman RR, Woodward M, Gupta A, Adler AI, Wamil M, Sattar N, Cushman WC, McManus RJ, Teo K, Davis BR, Chalmers J, Pepine CJ, Rahimi K, Blood Pressure Lowering Treatment Trialists' Collaboration, Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis. Lancet Diabetes Endocrinol 2022;10: 645-654"><sup>9</sup></a></li>
    <li>De nyere metaanalyser er baseret p&aring; individuelle patient data og har demonstreret en relativ risikoreduktion i kardiovaskul&aelig;re h&aelig;ndelser p&aring; ca. 10% ved en reduktion i systolisk blodtryk p&aring; 5 mmHg hos patienter med hypertension uanset udgangsblodtryk, tidligere hjerte-kar-sygdom<a href=" " data-type="journal-reference" data-value="Blood Pressure Lowering Treatment Trialists' Collaboration, Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021;397: 1625-1636" data-value-piped="Blood Pressure Lowering Treatment Trialists' Collaboration|Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis.|Lancet|2021|397|1625-1636|33933205" data-url="reference-link" data-pubmedid="undefined" title="Blood Pressure Lowering Treatment Trialists' Collaboration, Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021;397: 1625-1636"><sup>8</sup></a>, alder<a href=" " data-type="journal-reference" data-value="Blood Pressure Lowering Treatment Trialists' Collaboration, Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet 2021;398: 1053-1064" data-value-piped="Blood Pressure Lowering Treatment Trialists' Collaboration|Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis.|Lancet|2021|398|1053-1064|34461040" data-url="reference-link" data-pubmedid="undefined" title="Blood Pressure Lowering Treatment Trialists' Collaboration, Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet 2021;398: 1053-1064"><sup>7</sup></a> og diabetes<a href=" " data-type="journal-reference" data-value="Nazarzadeh M, Bidel Z, Canoy D, Copland E, Bennett DA, Dehghan A, Davey Smith G, Holman RR, Woodward M, Gupta A, Adler AI, Wamil M, Sattar N, Cushman WC, McManus RJ, Teo K, Davis BR, Chalmers J, Pepine CJ, Rahimi K, Blood Pressure Lowering Treatment Trialists' Collaboration, Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis. Lancet Diabetes Endocrinol 2022;10: 645-654" data-value-piped="Nazarzadeh M, Bidel Z, Canoy D, Copland E, Bennett DA, Dehghan A, Davey Smith G, Holman RR, Woodward M, Gupta A, Adler AI, Wamil M, Sattar N, Cushman WC, McManus RJ, Teo K, Davis BR, Chalmers J, Pepine CJ, Rahimi K, Blood Pressure Lowering Treatment Trialists' Collaboration|Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis.|Lancet Diabetes Endocrinol|2022|10|645-654|35878651" data-url="reference-link" data-pubmedid="undefined" title="Nazarzadeh M, Bidel Z, Canoy D, Copland E, Bennett DA, Dehghan A, Davey Smith G, Holman RR, Woodward M, Gupta A, Adler AI, Wamil M, Sattar N, Cushman WC, McManus RJ, Teo K, Davis BR, Chalmers J, Pepine CJ, Rahimi K, Blood Pressure Lowering Treatment Trialists' Collaboration, Blood pressure-lowering treatment for prevention of major cardiovascular diseases in people with and without type 2 diabetes: an individual participant-level data meta-analysis. Lancet Diabetes Endocrinol 2022;10: 645-654"><sup>9</sup></a></li>
</ul>
<h3>Generelt om behandlingen</h3>
<ul>
    <li>Indikationen for behandling afh&aelig;nger&nbsp;f&oslash;rst og fremmest af eksisterende evidens. Dern&aelig;st af om der foreligger erkendt hjerte-kar-sygdom&nbsp;eller subklinisk kardiovaskul&aelig;r organskade, af den absolutte risiko for hjerte-kar-sygdom og af graden af hypertension</li>
    <li>S&aring; f&oslash;r start af behandling vurderes patientens samlede kardiovaskul&aelig;re risiko p&aring; baggrund af blodtryksniveau, tilstedev&aelig;relsen af andre risikofaktorer samt tilstedev&aelig;relsen af diabetes, hjerte-kredsl&oslash;bs-sygdom og nyresygdom samt organskade. Patientens kardiovaskul&aelig;re risiko kan derved inddeles i lav, middel, h&oslash;j eller meget h&oslash;j. Patienter med grad 1 hypertension uden andre risikofaktorer end blodtrykket og uden komplicerende sygdomme har lav risiko og kan blive observeret uden medicinsk behandling i en kortere eller l&aelig;ngere periode&nbsp;<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
    <li>Niveau af absolut risiko for apopleksi eller myokardieinfarkt indenfor 10 &aring;r:
    <ul>
        <li>Lav risiko: &lt; 15 %</li>
        <li>Middel risiko: 15-20 %</li>
        <li>H&oslash;j risiko: 20-30 %</li>
        <li>Meget h&oslash;j risiko: &gt;30 %</li>
    </ul>
    </li>
</ul>
<h3>Hvor hurtigt skal man starte behandling?</h3>
<ul>
    <li>Ved ukompliceret grad 1 hypertension med lav risiko for hjerte-kar-sygdom&nbsp;skal holdningen v&aelig;re afventende. Livsstils&aelig;ndring b&oslash;r fors&oslash;ges alene i ca. 3-6 m&aring;neder f&oslash;r eventuel opstart med medikament</li>
    <li>Varigheden af observationstiden f&oslash;r medicinsk behandling vil afh&aelig;nge af den samlede absolutte kardiovaskul&aelig;re risiko. Ved h&oslash;j risiko vil man starte hurtigt op</li>
    <li>Enkelte patientgrupper vil man starte i behandling straks, fx patienter med nyresygdom, diabetes eller hjerte-kar-sygdom</li>
</ul>
<h3>Ikke-medikamentel behandling</h3>
<ul>
    <li>B&oslash;r gennemf&oslash;res hos alle patienter med hypertension. Vigtigst er rygestop. Kostvejledning er vigtig for at opn&aring; additiv effekt med evt. samtidig&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/75020">statin</a>-behandling og for at begr&aelig;nse stor kalorie-, alkohol-, lakrids- og saltindtagelse</li>
    <li>Fysisk tr&aelig;ning, eventuelt i form af helt eller delvist superviseret fysisk tr&aelig;ning, er ligeledes vigtig. Der er h&oslash;j grad af evidens for at fysisk tr&aelig;ning reducerer b&aring;de systolisk og diastolisk blodtryk og forbedrer overlevelse<a href=" " data-type="journal-reference" data-value="Rijal A, Nielsen EE, Adhikari TB, Dhakal S, Maagaard M, Piri R, Neupane D, Gæde PH, Olsen MH, Jakobsen JC, Effects of adding exercise to usual care in patients with either hypertension, type 2 diabetes or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. Br J Sports Med 2023;57: 930-939" data-value-piped="Rijal A, Nielsen EE, Adhikari TB, Dhakal S, Maagaard M, Piri R, Neupane D, Gæde PH, Olsen MH, Jakobsen JC|Effects of adding exercise to usual care in patients with either hypertension, type 2 diabetes or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis.|Br J Sports Med|2023|57|930-939|36450440" data-url="reference-link" data-pubmedid="36450440" title="Rijal A, Nielsen EE, Adhikari TB, Dhakal S, Maagaard M, Piri R, Neupane D, Gæde PH, Olsen MH, Jakobsen JC, Effects of adding exercise to usual care in patients with either hypertension, type 2 diabetes or cardiovascular disease: a systematic review with meta-analysis and trial sequential analysis. Br J Sports Med 2023;57: 930-939"><sup>10</sup></a>. St&oslash;rst effekt opn&aring;s ved aerob tr&aelig;ning af moderat til h&oslash;j intensitet, men der er ogs&aring; effekt af b&aring;de dynamisk og isometrisk styrketr&aelig;ning ligesom af almindelig gang tr&aelig;ning. Et nyligt cochrane review finder s&aring;ledes moderat grad af evidens for at gang tr&aelig;ning kan reducere b&aring;de systolisk og diastolisk BT uafh&aelig;ngigt af alder og k&oslash;n<a href=" " data-type="journal-reference" data-value="Lee LL, Mulvaney CA, Wong YKY, Chan ES, Watson MC, Lin HH, Walking for hypertension. Cochrane Database Syst Rev 2021;2: CD008823" data-value-piped="Lee LL, Mulvaney CA, Wong YKY, Chan ES, Watson MC, Lin HH|Walking for hypertension.|Cochrane Database Syst Rev|2021|2|CD008823|33630309" data-url="reference-link" data-pubmedid="33630309" title="Lee LL, Mulvaney CA, Wong YKY, Chan ES, Watson MC, Lin HH, Walking for hypertension. Cochrane Database Syst Rev 2021;2: CD008823"><sup>11</sup></a> . Der findes et lin&aelig;rt dosis-respons forhold mellem m&aelig;ngde af tr&aelig;ning og effekt p&aring; blodtrykket. Det er desuden et generelt fund, at den st&oslash;rste effekt findes hos de patienter med de h&oslash;jeste blodtryk.</li>
    <li>Effekten antages at v&aelig;re multifaktorielt betinget og omfatter neurohumorale, vaskul&aelig;re og strukturelle adaptationer, herunder nedsat sympatikusinduceret vasokonstriktion i tr&aelig;net tilstand, nedsatte katekolaminniveauer, &oslash;get diastolisk fyldning af venstre ventrikel, &oslash;get endotelial vasodilatorfunktion, nedsat arteriel stivhed <a href=" " data-type="journal-reference" data-value="Lopes S, Afreixo V, Teixeira M, Garcia C, Leitão C, Gouveia M, Figueiredo D, Alves AJ, Polonia J, Oliveira J, Mesquita-Bastos J, Ribeiro F, Exercise training reduces arterial stiffness in adults with hypertension: a systematic review and meta-analysis. J Hypertens 2021;39: 214-222" data-value-piped="Lopes S, Afreixo V, Teixeira M, Garcia C, Leitão C, Gouveia M, Figueiredo D, Alves AJ, Polonia J, Oliveira J, Mesquita-Bastos J, Ribeiro F|Exercise training reduces arterial stiffness in adults with hypertension: a systematic review and meta-analysis.|J Hypertens|2021|39|214-222|32833924" data-url="reference-link" data-pubmedid="32833924" title="Lopes S, Afreixo V, Teixeira M, Garcia C, Leitão C, Gouveia M, Figueiredo D, Alves AJ, Polonia J, Oliveira J, Mesquita-Bastos J, Ribeiro F, Exercise training reduces arterial stiffness in adults with hypertension: a systematic review and meta-analysis. J Hypertens 2021;39: 214-222"><sup>12</sup></a>&nbsp;samt anti-inflammatoriske effekter. Den gavnlige effekt af tr&aelig;ning synes uafh&aelig;ngig af v&aelig;gttab</li>
</ul>
<h3>Medikamentel blodtryksbehandling</h3>
<ul>
    <li>Effekter
    <ul>
        <li>I placebokontrollerede unders&oslash;gelser eliminerer effektiv blodtryksneds&aelig;ttelse hele patientens overrisiko for apopleksi, men kun en del af overrisikoen for isk&aelig;misk hjertesygdom</li>
    </ul>
    </li>
    <li>Medikamentvalg
    <ul>
        <li>Reduktionen i kardiovaskul&aelig;re komplikationer ved blodtryksbehandling er uafh&aelig;ngig af pr&aelig;paratvalg, hvis man som f&oslash;rstevalg benytter lavdosis&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">thiazid</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II antagonist</a>&nbsp;eller&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">calciumantagonist</a></li>
        <li>Disse stofgrupper er derfor f&oslash;rstevalgspr&aelig;parater</li>
    </ul>
    </li>
    <li>Kombinationsbehandling
    <ul>
        <li>Er n&oslash;dvendig hos de fleste patienter. Gives mere end 2 antihypertensiva, b&oslash;r et&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99000">diuretikum</a>&nbsp;indg&aring; i behandlingen. Kombinationsbehandling giver additiv blodtryksreduktion, mens bivirkninger er mindre end additive</li>
    </ul>
    </li>
    <li>Supplement af&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/75020">statiner</a>?
    <ul>
        <li>Vurderes i forhold til totalrisiko hvor man med fordel kan bruge Score2. Hvis Score risikoen er over 2,5 (for yngre) - 7,5 (for &aelig;ldre) % for apopleksi eller blodprop i hjertet, er der indikation for at behandle LDL til under 2.6 mmol/l.&nbsp;Hvis blodtrykket f&oslash;rst er blevet behandlet for nyligt, benytter man det ubehandlede blodtryk i risikovurderingen. For personer med s&aelig;rlig h&oslash;j risiko for hjerte-kar-sygdom er behandlingsm&aring;let LDL under 1.8</li>
        <li> For patienter med diabetes eller hjerte-kar-sygdom&nbsp;er behandlingsm&aring;let for kolesterol endnu henholdsvis 1,8 og 1,4 mmol/l<a href="https://nbv.cardio.dk/dyslipidaemi" data-type="other-reference" data-value="Dansk Cardiologisk Selskab, behandlingsvejledning, dyslipidæmi" data-url="https://nbv.cardio.dk/dyslipidaemi" title="Dansk Cardiologisk Selskab, behandlingsvejledning, dyslipidæmi"><sup>13</sup></a>&nbsp;</li>
    </ul>
    </li>
</ul>
<h3>Behandlingskriterier ved hypertension</h3>
<ul>
    <li>Medikamentel behandling skal altid f&oslash;lges af ikke-medikamentel intervention</li>
    <li>Specificering af kriterier for medikamentel behandling iht.&nbsp;<a rel="noopener noreferrer" href="https://nbv.cardio.dk/hypertension" target="_blank">Dansk Cardiologisk Selskabs behandlingsvejledning for hypertension 2024</a>&nbsp;og internationale guidelines&nbsp;<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a>:
    <ul>
        <li>Alle med kompliceret hypertension - endeorganskade, kardiovaskul&aelig;r sygdom, diabetes mellitus, nefropati</li>
        <li>Alle med grad 2-3 hypertension</li>
        <li>Ved grad 1 hypertension med lav kardiovaskul&aelig;r risiko (&lt;15 % absolut risiko for akut myokardieinfarkt eller apopleksi indenfor 10 &aring;r) kan tilstanden ses an i 3-6 m&aring;neder uden blodtryksneds&aelig;ttende medicin efter r&aring;d om non-farmakologiske tiltag. Er blodtrykket uforandret h&oslash;jt startes medikamentel antihypertensiv behandling</li>
    </ul>
    </li>
</ul>
<h3>R&aring;d til patienten</h3>
<ul>
    <li>Kortl&aelig;g patientens motivation for livsstils&aelig;ndringer</li>
</ul>
<h4>Generelt</h4>
<ul>
    <li>Egenbehandling b&oslash;r altid indg&aring; i hypertensionsbehandlingen</li>
    <li>Patienten skal have indsigt i, hvor vigtigt det er at p&aring;virke de andre risikofaktorer - det er den totale absolutte risiko, der er afg&oslash;rende</li>
    <li>Der er mest dokumentation for effekt af livsstils&aelig;ndring i sekund&aelig;r-pr&aelig;ventive studier</li>
</ul>
<h4>Tiltag, oversigt</h4>
<ul>
    <li>Rygestop</li>
    <li>Reduktion af evt. alkohol-overforbrug</li>
    <li>Motion</li>
    <li>Kostoml&aelig;gning</li>
    <li>V&aelig;gtreduktion ved overv&aelig;gt</li>
</ul>
<h4>Kost&aelig;ndring</h4>
<ul>
    <li>Generelt anbefales hjertesunde kostvaner med udgangspunkt i F&oslash;devarestyrelsens officielle kostr&aring;d</li>
    <li>Reducer saltindtaget
    <ul>
        <li>Danskernes gennemsnitlige saltindtag er ca. 10 gram/d&oslash;gn. St&oslash;rstedelen (70-80 %)&nbsp;af dette findes i f&oslash;devarerne, f&oslash;r de bliver k&oslash;bt. Resten tils&aelig;ttes i k&oslash;kkenet og ved spisebordet</li>
        <li>Ern&aelig;ringsr&aring;det har anbefalet, at befolkningens saltindtag gradvis neds&aelig;ttes til ca. 5 gram/d&oslash;gn ("<a href="http://www.dahs.dk/fileadmin/user_upload/Saltfolder_webversion_200813.pdf">Spis mad med mindre salt</a>")</li>
        <li>Reduceret indtag af salt er vist at reducere blodtrykket b&aring;de hos hypertensionspatienter og i den raske befolkning, ogs&aring; hos b&oslash;rn<a href="%20" title="Feng JHE, MacGregor GA, Salt reduction lowers cardiovascular risk: Meta-analysis of outcome trials. Lancet 2011;378: 380-82" data-url="reference-link" data-value="Feng JHE, MacGregor GA, Salt reduction lowers cardiovascular risk: Meta-analysis of outcome trials. Lancet 2011;378: 380-82" data-type="journal-reference" data-value-piped="Feng JHE, MacGregor GA|Salt reduction lowers cardiovascular risk: Meta-analysis of outcome trials|Lancet|2011|378|380-82"><sup>14</sup></a></li>
    </ul>
    </li>
    <li>Spis mere frugt og gr&oslash;nt (6 om dagen)</li>
    <li>Reducer fedt- og kulhydratindtaget</li>
    <li>&Oslash;g andelen af um&aelig;ttet fedt</li>
    <li>Afmagring ved overv&aelig;gt</li>
</ul>
<h4>Fysisk aktivitet</h4>
<ul>
    <li>Patienter med forh&oslash;jet BT b&oslash;r som minimum stile mod at opfylde Sundhedsstyrelsens generelle anbefalinger for fysisk aktivitet, men kan opn&aring; st&oslash;rre blodtryksreducerende effekt ved &oslash;get m&aelig;ngde af tr&aelig;ning samt tr&aelig;ning ved h&oslash;jere intensitet</li>
    <li>Det kan i denne forbindelse s&aelig;rligt anbefales at &oslash;ge frekvensen af aerob tr&aelig;ning, da den akutte blodtrykss&aelig;nkende effekt af aerob tr&aelig;ning er vist at vare i 24 timer<br>
    <span></span></li>
    <li>Tr&aelig;ningen b&oslash;r individualiseres og skal tage hensyn til comorbiditeter, s&aring;som symptomgivende hjertesygdom. Tr&aelig;ningen kan eventuelt helt eller delvist superviseres</li>
    <li>At &oslash;ge den daglige aktivitet vil give en betydelig sundhedsgevinst, fx g&aring; p&aring; trapper, cykle i stedet for at bruge bilen osv.</li>
    <li>B&aring;de aktiviteter som p&aring;virker udholdenhed og styrke vil v&aelig;re gunstig for personer med hypertension</li>
    <li>Relative kontraindikationer: B&aring;de American College of Sports Medicine og Australian Association for Exercise and Sports Science anbefaler at fysisk tr&aelig;ning udskydes for patienter med SBT &gt; 180 eller DBT &gt; 105, indtil dette er s&aelig;nket farmakologisk. Ligeledes anbefales forsigtighed ved meget tunge l&oslash;ft, s&aelig;rligt hos patienter med venstresidig ventrikelhypertrofi, da dette kan medf&oslash;re meget h&oslash;jt tryk i venstre ventrikel<a href=" " data-type="journal-reference" data-value=", American College of Sports Medicine. Position Stand. Physical activity, physical fitness, and hypertension. Med Sci Sports Exerc 1993;25: i-x" data-value-piped="|American College of Sports Medicine. Position Stand. Physical activity, physical fitness, and hypertension.|Med Sci Sports Exerc|1993|25|i-x|8231750" data-url="reference-link" data-pubmedid="8231750" title=", American College of Sports Medicine. Position Stand. Physical activity, physical fitness, and hypertension. Med Sci Sports Exerc 1993;25: i-x"><sup>15</sup></a><sup>,</sup><a href=" " data-type="journal-reference" data-value="Sharman JE, Stowasser M, Australian association for exercise and sports science position statement on exercise and hypertension. J Sci Med Sport 2009;12: 252-7" data-value-piped="Sharman JE, Stowasser M|Australian association for exercise and sports science position statement on exercise and hypertension.|J Sci Med Sport|2009|12|252-7|19147407" data-url="reference-link" data-pubmedid="19147407" title="Sharman JE, Stowasser M, Australian association for exercise and sports science position statement on exercise and hypertension. J Sci Med Sport 2009;12: 252-7"><sup>16</sup></a></li>
</ul>
<h4>Rygestop</h4>
<ul>
    <li>Se artiklen om&nbsp;<a href="~/link.aspx?_id=1718EAA340E545A29BC399D70243B208&amp;_z=z">rygeafv&aelig;nning</a></li>
</ul>
<h3>Medicinsk behandling</h3>
<h4>Generelle behandlingsr&aring;d</h4>
<ul>
    <li>Tidlig medikamentel behandling kan anbefales ved h&oslash;jt tryk, organskade eller defineret h&oslash;j totalrisiko</li>
    <li>Ved grad 1 hypertension startes med monoterapi. Ved grad 2 hypertension kan startes med monoterapi eller kombinationsbehandling, eventuelt tabletter med fast kombination af flere antihypertensiva. Det tilstr&aelig;bes at n&aring; behandlingsm&aring;let i l&oslash;bet af 3-6 m&aring;neder. Patienter med grad 3 hypertension og alvorlige symptomer indl&aelig;gges ofte. Patienter med grad 3 hypertension uden symptomer kan startes med kombinationsterapi. Ved grad 3 hypertension kan en for drastisk reduktion af blodtrykket give isk&aelig;miske symptomer fra hjerne og hjerte. Man kan tilstr&aelig;be fx 25 % reduktion af blodtrykket initialt, og derefter vurdere patienten mhp. den videre behandling</li>
    <li>Undg&aring; mere end to doseringstider daglig</li>
    <li>Sp&oslash;rg om bivirkninger</li>
    <li>Manglende behandlingsrespons kan ogs&aring; skyldes d&aring;rlig patientcompliance</li>
</ul>
<h4>Medikamentvalg, generelt</h4>
<ul>
    <li>Overordnet m&aring;l
    <ul>
        <li>Behandling uden bivirkninger, normalisering af blodtrykket og dokumenteret effekt p&aring; sygdom og d&oslash;d</li>
        <li>Ny viden godtg&oslash;r, at natblodtrykket har afg&oslash;rende betydning for den kardiovaskul&aelig;re risiko. Det er derfor vigtigt, at der gives en antihypertensiv behandling, der er d&oslash;gnd&aelig;kkende. Tidspunktet for medicinindtag er dog uden selvst&aelig;ndig prognostisk betydning&nbsp;<a href=" " data-type="journal-reference" data-value="Stergiou G, Brunström M, MacDonald T, Kyriakoulis KG, Bursztyn M, Khan N, Bakris G, Kollias A, Menti A, Muntner P, Orias M, Poulter N, Shimbo D, Williams B, Adeoye AM, Damasceno A, Korostovtseva L, Li Y, Muxfeldt E, Zhang Y, Mancia G, Kreutz R, Tomaszewski M, Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022;40: 1847-1858" data-value-piped="Stergiou G, Brunström M, MacDonald T, Kyriakoulis KG, Bursztyn M, Khan N, Bakris G, Kollias A, Menti A, Muntner P, Orias M, Poulter N, Shimbo D, Williams B, Adeoye AM, Damasceno A, Korostovtseva L, Li Y, Muxfeldt E, Zhang Y, Mancia G, Kreutz R, Tomaszewski M|Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension.|J Hypertens|2022|40|1847-1858|35983870" data-url="reference-link" data-pubmedid="35983870" title="Stergiou G, Brunström M, MacDonald T, Kyriakoulis KG, Bursztyn M, Khan N, Bakris G, Kollias A, Menti A, Muntner P, Orias M, Poulter N, Shimbo D, Williams B, Adeoye AM, Damasceno A, Korostovtseva L, Li Y, Muxfeldt E, Zhang Y, Mancia G, Kreutz R, Tomaszewski M, Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022;40: 1847-1858"><sup>17</sup></a> s&aring;fremt man sikrer ordentlig d&oslash;gnd&aelig;kning m&aring;lt med hjemmeblodtryk morgen og aften f&oslash;r medicinindtag&nbsp;</li>
    </ul>
    </li>
    <li>Polyfarmaci
    <ul>
        <li>Hos over halvdelen m&aring; der anvendes flere medikamenter for at n&aring; m&aring;let. Det kan v&aelig;re en fordel at anvende kombinationstabletter af hensyn til compliance</li>
    </ul>
    </li>
    <li>Effekter
    <ul>
        <li>Dokumenteret langtidseffekt foreligger for&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">thiazider</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#a000">betablokkere</a>,<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">&nbsp;ACE-h&aelig;mmere</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">calciumantagonister</a>&nbsp;og&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II-receptor blokkere</a></li>
        <li>Lavdosis&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">thiazider</a>
        <ul>
            <li>Anbefales i <a rel="noopener noreferrer" href="https://nbv.cardio.dk/hypertension" target="_blank">Dansk Cardiologisk Selskabs behandlingsvejledning for hypertension 2024</a>&nbsp;til &aelig;ldre hypertensionspatienter. F&oslash;r behandlingsstart skal patienten dog unders&oslash;ges for tendens til ortostatisk blodtryksfald, der findes hos ca. 10 % af &aelig;ldre, og som vil kunne forv&aelig;rres af&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">thiazid</a></li>
            <li>Vigtigste bivirkninger er erektil dysfunktion og fremprovokering af type 2-diabetes. Disse mulige bivirkninger g&oslash;r mange praktiserende l&aelig;ger tilbageholdende med&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">thiaziderne</a>&nbsp;til symptomfrie hypertensionspatienter</li>
            <li>De nyeste britiske NICE-guidelines fra 2011 anbefaler det thiazidlignende&nbsp;[DliActiveSubstance;5827;indapamid]&nbsp;og det thiazidlignende chlortalidon (afregistreret i Danmark) frem for thiaziderne&nbsp;[DliActiveSubstance;5685;bendroflumethiazid]&nbsp;og&nbsp;[DliActiveSubstance;6864;hydrochlorthiazid]&nbsp;til de &aelig;ldre hypertensionspatienter</li>
            <li>Hydrochlorthiazid i daglige doser p&aring; 25 mg eller mere i mere end 3 &aring;r (kumulativ effekt) er blevet forbundet med &oslash;get risiko for hudkr&aelig;ft, overvejende lavmaligne former<a href="EditorPage.aspx?da=core&amp;id=%7B9F347DAC-32D6-4CF3-9637-4F9DF6892F09%7D&amp;ed=FIELD13071665019&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H13071665408&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Pottegård A, Hallas J, Olesen M, Svendsen MT, Habel LA, Friedman GD, Friis S, Hydrochlorothiazide use is strongly associated with risk of lip cancer. J Intern Med 2017;282: 322-331" data-value-piped="Pottegård A, Hallas J, Olesen M, Svendsen MT, Habel LA, Friedman GD, Friis S|Hydrochlorothiazide use is strongly associated with risk of lip cancer.|J Intern Med|2017|282|322-331|28480532" data-url="reference-link" data-pubmedid="28480532" title="Pottegård A, Hallas J, Olesen M, Svendsen MT, Habel LA, Friedman GD, Friis S, Hydrochlorothiazide use is strongly associated with risk of lip cancer. J Intern Med 2017;282: 322-331"><sup>18</sup></a></li>
        </ul>
        </li>
        <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">Betablokkere</a>
        <ul>
            <li>[DliActiveSubstance;5152;Atenolol&nbsp;]er vist at v&aelig;re et d&aring;rligere f&oslash;rstevalgspr&aelig;parat end en r&aelig;kke andre medikamenter</li>
            <li>En svensk metaanalyse konkluderer, at betablokkere giver d&aring;rligere forebyggelse af apopleksi end andre antihypertensiva, og at de derfor ikke b&oslash;r v&aelig;re f&oslash;rstevalg i behandlingen af hypertension<a href="%20" title="Lindholm LH, Carlberg B, Samuelsson O, Should ? blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005;366: 1545-53" data-url="reference-link" data-value="Lindholm LH, Carlberg B, Samuelsson O, Should ? blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005;366: 1545-53" data-type="journal-reference" data-value-piped="Lindholm LH, Carlberg B, Samuelsson O|Should ? blockers remain first choice in the treatment of primary hypertension? A meta-analysis|Lancet|2005|366|1545-53"><sup>19</sup></a></li>
            <li>Heller ikke i Storbritannien er betablokkere f&oslash;rstevalg l&aelig;ngere</li>
            <li>Bivirkninger kan v&aelig;re erektil dysfunktion, fremprovokering af type 2-diabetes, nedsat fysisk aktivitetsevne og depressiv forstemning</li>
            <li><a rel="noopener noreferrer" href="https://nbv.cardio.dk/hypertension" target="_blank">Dansk Cardiologisk Selskabs behandlingsvejledning for hypertension 2024</a>&nbsp;har ligeledes fjernet&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">betablokkerne</a>&nbsp;som f&oslash;rstevalgspr&aelig;parater, medmindre patienten har isk&aelig;misk hjertesygdom</li>
        </ul>
        </li>
        <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">Calciumantagonister</a>
        <ul>
            <li>Calciumantagonister anbefales til &aelig;ldre hypertensionspatienter. De britiske NICE-guidelines fra 2011 og tidligere anbefaler&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">calciumantagonister</a>&nbsp;som f&oslash;rstevalg hos hypertensionspatienter over 55 &aring;r</li>
            <li>Dog viser et andet studie af kvinder 50-79 &aring;r, at&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/99012">thiazid</a>&nbsp;+&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#a000">betablokker</a>&nbsp;eller&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer&nbsp;</a>gav reduceret kardiovaskul&aelig;r mortalitet, mens&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/grupper/99012">thiazid</a>&nbsp;+&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">calciumblokker</a>&nbsp;ikke gjorde det</li>
            <li>Bivirkninger kan v&aelig;re h&aelig;velse af benene pga. vasodilatation samt hovedpine</li>
        </ul>
        </li>
        <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmere</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II antagonister</a>:
        <ul>
            <li>Er f&oslash;rstevalgspr&aelig;parater hos diabetikere med hypertension</li>
            <li>Kan v&aelig;re indiceret ved hypertension med hjerteinsufficiens</li>
            <li>M&aring; ikke gives til gravide, kan medf&oslash;re misdannelser hos fosteret. Ved planlagt graviditet skiftes forud til anden pr&aelig;paratgruppe. Ved konstatering af ikke-planlagt graviditet skiftes ligeledes pr&aelig;parat. Er is&aelig;r aktuelt hos unge kvinder med diabetes og hypertension</li>
            <li>Bivirkninger til&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;kan v&aelig;re t&oslash;r hoste, der ses hos ca. 10 %. Forsvinder ved skift til&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II antagonist</a>. En mere alvorlig bivirkning af&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmere</a>&nbsp;er lokaliseret allergisk &oslash;dem (Quincke-&oslash;dem), der ofte sidder omkring munden, og som kan v&aelig;re livstruende, hvis det sidder i pharynx. Ses hos ca. 0,5 % af behandlede, dels ved behandlingsstart og dels efter l&aelig;ngere tids behandling. Skal medf&oslash;re &oslash;jeblikkelig seponering af&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>. Kan ogs&aring; ses ved behandling med&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II-antagonister</a>&nbsp;men er her v&aelig;sentligt sj&aelig;ldnere</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Komplicerende sygdomme
    <ul>
        <li>V&aelig;lg optimale medikamenter ved supplerende sygdomme som angina pectoris, hjertesvigt, arytmi, diabetes, urinsyregigt og astma</li>
        <li>Brug af&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96010">kardioselektive betablokkere</a>
        <ul>
            <li>Synes ikke at forv&aelig;rre lungesygdomme og b&oslash;r kunne gives til patienter med mild til moderat reversibel sygdom</li>
            <li>Uafklaret om de kan forv&aelig;rre akutte eksacerbationer</li>
        </ul>
        </li>
    </ul>
    </li>
</ul>
<h4>Hypertension uden anden sygdom</h4>
<p>Britiske anbefalinger&nbsp;er foresl&aring;et brugt i Danmark:</p>
<table>
    <tbody>
        <tr>
            <td style="text-align: left;"></td>
            <td style="text-align: left;">&lt; 55 &aring;r og ikke afro-etn.</td>
            <td style="text-align: left;">&gt; 55 &aring;r eller afro-etn.</td>
        </tr>
        <tr>
            <td style="text-align: left;">Trin 1</td>
            <td style="text-align: left;">A</td>
            <td style="text-align: left;">C eller D</td>
        </tr>
        <tr>
            <td style="text-align: left;">Trin 2</td>
            <td colspan="2" style="text-align: left;">A + C eller D</td>
        </tr>
        <tr>
            <td style="text-align: left;">Trin 3</td>
            <td colspan="2" style="text-align: left;">A + C + D</td>
        </tr>
        <tr>
            <td style="text-align: left;">Trin 4<br>
            Resistent hypertension</td>
            <td colspan="2" style="text-align: left;">Till&aelig;g enten&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">beta-blokker</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97045">alfa-blokker</a>&nbsp;eller&nbsp;[DliActiveSubstance;5655;spironolacton]&nbsp;eller andet diuretikum</td>
        </tr>
    </tbody>
</table>
<ul>
    <li>Ved afro etn. forst&aring;s personer med afrikansk eller afro-karibeansk etnicitet</li>
    <li>A -&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;eller&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin-II-blokker</a>. Disse m&aring; ikke gives til gravide og m&aring; ikke gives ved mistanke om renovaskul&aelig;r hypertension</li>
    <li>C -&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">Calcium blokkere</a></li>
    <li>D - Diuretika (<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">tiazider</a>)</li>
    <li>Der er ikke fuld enighed om ovenst&aring;ende skema, der fx ikke er anf&oslash;rt i Dansk Hypertensionsselskabs behandlingsvejledning fra 2015</li>
    <li>Det nye Pathway 2 studium underst&oslash;tter brugen af [DliActiveSubstance;5655;spironolacton]&nbsp;ved Trin 4&nbsp;<a href="EditorPage.aspx?da=core&amp;id=%7B9F347DAC-32D6-4CF3-9637-4F9DF6892F09%7D&amp;ed=FIELD13071665019&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H13071665408&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, Ford I, Cruickshank JK, Caulfield MJ, Salsbury J, Mackenzie I, Padmanabhan S, Brown MJ, British Hypertension Society's PATHWAY Studies Group., Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet 2015;386: 2059-2068" data-value-piped="Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, Ford I, Cruickshank JK, Caulfield MJ, Salsbury J, Mackenzie I, Padmanabhan S, Brown MJ, British Hypertension Society's PATHWAY Studies Group.|Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial.|Lancet|2015|386|2059-2068|26414968" data-url="reference-link" data-pubmedid="26414968" title="Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, Ford I, Cruickshank JK, Caulfield MJ, Salsbury J, Mackenzie I, Padmanabhan S, Brown MJ, British Hypertension Society's PATHWAY Studies Group., Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet 2015;386: 2059-2068"><sup>20</sup></a></li>
</ul>
<h4>Hypertensionsbehandling hos personer over 80 &aring;r?</h4>
<ul>
    <li>Der findes sparsomme data, og erfaringerne er blandede</li>
    <li>Nogle studier viser reduceret risiko for apopleksi, nogle studier viser &oslash;get totalmortalitet - s&aelig;rlig hvis m&aring;let er at opn&aring; systolisk blodtryk &lt; 140</li>
    <li>I et publiceret britisk ledet internationalt multicenterstudie, HYVET-studiet (2008) blev patienter &gt; 80 &aring;r med systolisk blodtryk mellem 160 og 199 behandlet med et diuretikum ([DliActiveSubstance;5827;indapamid]) + evt. en&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;([DliActiveSubstance;6169;perindopril]). Resultaterne viste i forhold til placebo en reduceret risiko for fatal apopleksi, d&oslash;d fra enhver &aring;rsag samt hjerteinsufficiens<a href="%20" title="Beckett NS, Peters R, Fletcher AE, et al, for the HYVET Study Group, Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358: 1887-98" data-url="reference-link" data-value="Beckett NS, Peters R, Fletcher AE, et al, for the HYVET Study Group, Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358: 1887-98" data-type="journal-reference" data-value-piped="Beckett NS, Peters R, Fletcher AE, et al, for the HYVET Study Group|Treatment of hypertension in patients 80 years of age or older|N Engl J Med|2008|358|1887-98"><sup>21</sup></a></li>
    <li>I et stort NIH multicenter studium, SPRINT<a href=" " data-type="journal-reference" data-value="SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT, A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015;373: 2103-16" data-value-piped="SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT|A Randomized Trial of Intensive versus Standard Blood-Pressure Control.|N Engl J Med|2015|373|2103-16|26551272" data-url="reference-link" data-pubmedid="26551272" title="SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT, A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015;373: 2103-16"><sup>22</sup></a>&nbsp;og et SPRINT substudium&nbsp;reducerede en mere intensiv blodtryksbehandling incidensen af hjerte-kar-sygdom&nbsp;selv hos patienter &aelig;ldre end 75 &aring;r&nbsp;</li>
    <li>V&aelig;lger man at behandle et forh&oslash;jet blodtryk hos de meget gamle patienter, skal man v&aelig;re meget opm&aelig;rksom p&aring; eventuel ortostatisk hypotension, der kan blive forv&aelig;rret af antihypertensiv behandling</li>
    <li>Behandlingsm&aring;let i denne aldersgruppe vil pga. HYVET og SPRINT typisk v&aelig;re et systolisk hjemmeblodtryk p&aring; 130-145 mmHg uden fald i st&aring;ende stilling</li>
</ul>
<h4>Behandlingsresistent hypertension</h4>
<ul>
    <li>Behandlingsresistent hypertension foreligger, n&aring;r klinikblodtrykket vedvarende ligger over behandlingsm&aring;let (hjemmeblodtryk &lt; 135/85] trods behandling med tre eller flere antihypertensiva, hvoraf et skal v&aelig;re et diuretika<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
    <li>Pr&aelig;valensen af behandlingsresistent hypertension ligger i et spansk og et amerikansk studie omkring 12 % af behandlede hypertensionspatienter. Mange patienter med tilsyneladende behandlingsresistent hypertension ved klinikm&aring;linger har white coat hypertension. Det er anf&oslash;rt, at pr&aelig;valensen af prim&aelig;r hyperaldosteronisme ved behandlingsresistent hypertension er omkring 20 %</li>
    <li>Andre mulige &aring;rsager er d&aring;rlig patientcompliance, excessiv saltindtagelse, brug af&nbsp;<a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/213010">NSAID</a>&nbsp;og obstruktiv s&oslash;vnapnoe</li>
    <li>[DliActiveSubstance;5655;Spironolacton]&nbsp;er en effektiv supplerende behandling ved resistent hypertension<a href="EditorPage.aspx?da=core&amp;id=%7B9F347DAC-32D6-4CF3-9637-4F9DF6892F09%7D&amp;ed=FIELD13071665019&amp;vs&amp;la=da&amp;fld=%7B850D32D3-55A1-49E4-9CDF-F0C88D91563C%7D&amp;so=%2Fsitecore%2Fsystem%2FSettings%2FHtml%20Editor%20Profiles%2FRich%20Text%20LHPH&amp;di=0&amp;hdl=H13071665408&amp;us=sitecore%5Canvi&amp;mo&amp;pe=0&amp;fbd=1" data-type="journal-reference" data-value="Oxlund CS, Henriksen JE, Tarnow L, Schousboe K, Gram J, Jacobsen IA, Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial. J Hypertens 2013;31: 2094-102" data-value-piped="Oxlund CS, Henriksen JE, Tarnow L, Schousboe K, Gram J, Jacobsen IA|Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial.|J Hypertens|2013|31|2094-102|24107738" data-url="reference-link" data-pubmedid="24107738" title="Oxlund CS, Henriksen JE, Tarnow L, Schousboe K, Gram J, Jacobsen IA, Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial. J Hypertens 2013;31: 2094-102"><sup>23</sup></a>&nbsp;</li>
    <li>To nye behandlingstilbud til patienter med behandlingsresistent hypertension, hvor de ovenn&aelig;vnte &aring;rsager kan udelukkes, er renal denervering eller baroreceptor stimulation. F&oslash;rstn&aelig;vnte udf&oslash;res intraarterielt med et kateter, der destruerer nerverne i arteria renalis' v&aelig;g med mikrob&oslash;lger. Behandling vha. baroreceptor stimulation er meget dyr, idet behandlingen kr&aelig;ver dyrt udstyr (elektrode og batteri) samt karkirurgisk ekspertise til implantation i fuld an&aelig;stesi. Ingen af behandlingerne tilbydes aktuelt (2023) i Danmark, men man overvejer at genoptage renal denervering, fordi nyere randomiserede studier viser en blodtryksreducerende effekt p&aring; 5-10 mmHg</li>
    <li>Patienter med behandlingsresistent hypertension b&oslash;r henvises til specialist eller specialafdeling</li>
</ul>
<h4>Supplerende omtale</h4>
<ul>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97045">Alfablokkere</a>
    <ul>
        <li>Anbefales ikke som f&oslash;rstevalg, men kan v&aelig;re et effektivt antihypertensivum som supplerende medikament hos yngre</li>
    </ul>
    </li>
    <li>Direkte reninh&aelig;mmere:&nbsp;[DliActiveSubstance;5053;Aliskiren]&nbsp;er det eneste stof p&aring; markedet. Dets plads i hypertensionsbehandlingen er usikker. En kontrolleret randomiseret unders&oslash;gelse af patienter med diabetisk nefropati, hvor aliskiren eller placebo blev givet som add-on behandling til&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;eller&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II antagonist</a>, blev standset i 2011 pga. en &oslash;get forekomst af alvorlige bivirkninger i aliskirengruppen: hypotension, apopleksi, hyperkali&aelig;mi, aftagende nyrefunktion.&nbsp;[DliActiveSubstance;5053;Aliskiren]&nbsp;m&aring; derefter ikke mere gives i kombination med de andre blokkere af renin-angiotensinsystemet og er derfor ikke et f&oslash;rstevalgspr&aelig;parat</li>
</ul>
<h4>Hypertension ved samtidig angina</h4>
<ul>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">Betablokker</a>
    <ul>
        <li>Er f&oslash;rstevalg - antihypertensiv og antiangin&oslash;s effekt</li>
    </ul>
    </li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">Calciumblokker</a>
    <ul>
        <li>Hvis kontraindikation eller bivirkning af betablokker</li>
    </ul>
    </li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95014">Langtidsvirkende nitrater</a>
    <ul>
        <li>Har ogs&aring; en vis antihypertensiv effekt</li>
        <li>Bruges alene eller sammen med&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">betablokker</a>/<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">calciumblokker</a></li>
    </ul>
    </li>
</ul>
<h4>Hypertension efter akut myokardieinfarkt</h4>
<ul>
    <li>Hjemmeblodtryk over 130/80 mmHg behandles med et behandlingsm&aring;l 120-130/60-80 mmHg</li>
    <li>Der anbefales livsstilsmodifikation med rygestop, kost&aelig;ndring med reduceret saltindtag, v&aelig;gttab ved overv&aelig;gt samt motion</li>
    <li>Medicinsk behandling med&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">beta-blokker</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;eller&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II- antagonist</a></li>
</ul>
<h4>Hypertension ved samtidigt hjertesvigt</h4>
<ul>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>
    <ul>
        <li>F&oslash;rstevalg</li>
        <li>Hjertesvigt-behandling og antihypertensiv effekt</li>
    </ul>
    </li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99030">Loop-diuretika</a>
    <ul>
        <li>Er oftest aktuelt som supplement</li>
        <li>Ogs&aring; kombineret virkning, blodtryks&aelig;nkende og svigtkompenserende</li>
        <li>Brug gerne langtidsvirkende diuretika (tabletter med protraheret absorption)</li>
    </ul>
    </li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/315446">Betablokker</a>
    <ul>
        <li>Er aktuelt og godt dokumenteret</li>
        <li>Forsigtig start og optrapning af dosis, hyppige kontroller</li>
    </ul>
    </li>
    <li>[DliActiveSubstance;5655;Spironolacton]
    <ul>
        <li>Er et godt dokumenteret supplementsmedikament til&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99030">loop-diuretika</a>&nbsp;ved hjertesvigt</li>
    </ul>
    </li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">A-II-antagonist</a>
    <ul>
        <li>Effekten p&aring; h&aring;rde endepunkter var lidt bedre med losartan end med atenolol i LIFE-studiet, men uden fortrin i SCOPE- og VALUE-studierne</li>
        <li>Alternativ til behandling med ACE-h&aelig;mmer, s&aring;fremt denne ikke kan benyttes</li>
    </ul>
    </li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">Calciumantagonister</a>
    <ul>
        <li>Er et alternativ, men den forebyggende effekt p&aring; hjertesvigt er noget mindre end ovenn&aelig;vnte pr&aelig;parater</li>
        <li>[DliActiveSubstance;6305;Verapamil]&nbsp;og&nbsp;[DliActiveSubstance;6335;diltiazem]&nbsp;er kontraindiceret ved hjerteinsufficiens p&aring; grund af negativ inotrop effekt</li>
    </ul>
    </li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95014">Nitrater, langtidsvirkende</a>
    <ul>
        <li>Aktuelt som supplement</li>
    </ul>
    </li>
</ul>
<h4>Hypertension ved samtidig diabetes type 1 og 2 (med eller uden nefropati)</h4>
<ul>
    <li>Uden nefropati
    <ul>
        <li>Ingen holdepunkter for specielle pr&aelig;ferencer. Trods dette anbefaler guidelines&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;eller&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II-antagonist</a>&nbsp;som f&oslash;rstevalg til alle diabetikere med hypertension. Der suppleres ofte med&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">thiazid</a>&nbsp;og l&aelig;gemidler fra de &oslash;vrige grupper af antihypertensiva</li>
    </ul>
    </li>
    <li>Med nefropati eller mikroalbuminuri
    <ul>
        <li>ACE-h&aelig;mmer er f&oslash;rstevalg, men m&aring; som regel kombineres med diuretikum: ved normal eller lettere nedsat nyrefunktion&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">thiazid</a>, ved v&aelig;sentligt nedsat nyrefunktion&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99030">loop-diuretikum</a>
        <ul>
            <li>Giver dokumenteret reduktion af albumin-udskillelse hos diabetikere</li>
            <li>Anbefales af nogle ogs&aring; til normotensive type 1-diabetikere med nefropati</li>
        </ul>
        </li>
        <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">Angiotensin-II-antagonist</a>&nbsp;kan bruges, hvis&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;ikke kan benyttes
        <ul>
            <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">A-II-antagonist</a>&nbsp;var i et sammenlignende studie ikke bedre end&nbsp;ACE-h&aelig;mmer</li>
            <li>Generelt anbefaler man ikke at kombinere&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;og&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">A-II-antagonist</a>&nbsp;<a href="%20" title="Mann JF, Schmieder RE, McQueen M, et al., for the ONTARGET investigators, Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008;372: 547-53" data-url="reference-link" data-value="Mann JF, Schmieder RE, McQueen M, et al., for the ONTARGET investigators, Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008;372: 547-53" data-type="journal-reference" data-value-piped="Mann JF, Schmieder RE, McQueen M, et al., for the ONTARGET investigators|Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial|Lancet|2008|372|547-53"><sup>24</sup></a>, men i s&aelig;rlige situationer kan det g&oslash;res ved samtidig omhyggelig kontrol af nyrefunktion</li>
        </ul>
        </li>
        <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">Calciumblokker</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97045">alfablokker</a>,&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">betablokker</a>&nbsp;er aktuelle terapivalg efter ovenst&aring;ende&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;
        <ul>
            <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">Calciumblokkere</a>&nbsp;har f&aring; bivirkninger, lipidneutralt</li>
            <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">Betablokker</a>&nbsp;kan bruges, men kan maskere symptomer p&aring; hypoglyk&aelig;mi</li>
        </ul>
        </li>
    </ul>
    </li>
    <li>Diabetes, hypertension og tegn p&aring; venstre ventrikelhypertrofi&nbsp;
    <ul>
        <li>F&oslash;rstevalg er <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">A-II-antagonister</a>, specielt [DliActiveSubstance;5426;losartan], og andetvalg er <a href="https://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer&nbsp;</a></li>
        <li>I LIFE-studiet reducerede&nbsp;[DliActiveSubstance;5426;losartan]&nbsp;(<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038#">A-II-antagonist</a>) kardiovaskul&aelig;r morbiditet og mortalitet samt total d&oslash;delighed mere end&nbsp;[DliActiveSubstance;5152;atenolol]</li>
        <li>Men hverken SCOPE-studiet ([DliActiveSubstance;5766;candesartan]) eller VALUE-studiet ([DliActiveSubstance;5721;valsartan]) viste tilsvarende reduktion i kardiovaskul&aelig;r morbiditet og mortalitet af&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038#">A-II-antagonister</a></li>
        <li>Diabetikere udgjorde kun en mindre andel af patienterne i disse studier</li>
        <li>I de tre studier var der nedsat forekomst af nyopst&aring;et diabetes hos de patienter, som brugte&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin-II antagonister</a>&nbsp;sammenlignet med kontrolgrupperne</li>
    </ul>
    </li>
</ul>
<h4>Hypertension ved samtidig arytmi</h4>
<ul>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">Betablokker</a>&nbsp;og/eller calciumblokkeren&nbsp;[DliActiveSubstance;6305;verapamil]&nbsp;ved atrieflimmer og supraventrikul&aelig;r arytmi</li>
</ul>
<h4>Hypertension ved samtidig astma</h4>
<ul>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">Tiazider</a></li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;kan v&aelig;re f&oslash;rstevalg</li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">Calciumblokker</a>&nbsp;kan v&aelig;re aktuelt</li>
    <li>Undg&aring;&nbsp;betablokker</li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97045">Alfa-blokker</a>&nbsp;og&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">AII-antagonist</a>&nbsp;kan v&aelig;re aktuelt</li>
</ul>
<h4>Hypertension ved samtidig hyperurik&aelig;mi</h4>
<ul>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96000#IndledningLK">Betablokker</a></li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">Calciumblokker</a></li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-I</a>&nbsp;eller&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">A-II-antagonist</a></li>
    <li><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97045">Alfablokker</a></li>
    <li>Undg&aring;&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/99012">tiazider</a>&nbsp;ved symptomgivende urinsyre-gigt</li>
</ul>
<h4>Hypertension ved samtidig reduceret nyrefunktion</h4>
<ul>
    <li>Ved hypertension med kronisk progredierende nefropati anvendes&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;eller&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">angiotensin II antagonist</a>&nbsp;som en afg&oslash;rende del af den progressionsh&aelig;mmende behandling. Denne behandlingsstrategi er baseret p&aring; mange randomiserede studier, hvor&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>/<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">A-II-antagonist</a>&nbsp;har vist bedre progressionsh&aelig;mning end andre antihypertensiva med samme blodtryksreduktion. Der m&aring; ofte bruges diuretikum ([DliActiveSubstance;5347;furosemid]) og yderligere antihypertensiva, men trods dette kan det undertiden v&aelig;re vanskeligt at n&aring; behandlingsm&aring;let p&aring; hjemmeblodtryk &lt;130/80 mmHg</li>
    <li>Ved hypertension med nefrosklerose med en let grad af proteinuri (&lt;0,5-1 g/d&oslash;gn) og normal til lettere nedsat nyrefunktion er det formentlig mindre afg&oslash;rende, hvilke antihypertensiva der v&aelig;lges, n&aring;r blot man n&aring;r behandlingsm&aring;let p&aring; hjemmeblodtryk &lt;130/80 mmHg. S&aring;ledes fandtes i en kontrolleret unders&oslash;gelse af hypertensive patienter med h&oslash;j kardiovaskul&aelig;r risiko men ringe renal risiko samme lave hyppighed af renale endepunkter over en 6-&aring;rs periode under basisbehandling med&nbsp;[DliActiveSubstance;5084;amlodipin]&nbsp;(<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/95022">calciumantagonist</a>),&nbsp;[DliActiveSubstance;5414;lisinopril]&nbsp;(<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>) og <a href="~/link.aspx?_id=9F347DAC32D64CF396374F9DF6892F09&amp;_z=z">chlortalidon</a>&nbsp;(thiazidlignende) ALLHAT)</li>
</ul>
<h4>Hypertension efter apoplexia cerebri og TCI</h4>
<ul>
    <li>Hypertension er en markant, reversibel risikofaktor for recidiv af apopleksi</li>
    <li>Danske studier viser at ca. 60 % af apopleksipatienter, der er i live et &aring;r efter hospitalsudskrivelse, er hypertensive. Det g&aelig;lder b&aring;de hos patienter med og uden antihypertensiv behandling. Der er s&aring;ledes mulighed for ved en aktiv antihypertensiv behandling at forebygge recidiv af apopleksier i h&oslash;jere grad, end det sker nu</li>
    <li>Antihypertensiv behandling skal ikke nystartes i den akutte fase af en apopleksi, men kan startes n&aring;r den neurologiske tilstand har v&aelig;ret stabil i 1-2 uger. Behandlingen startes med en lille dosis af et pr&aelig;parat fra en af f&oslash;rstevalgsgrupperne under observation af den kliniske tilstand. Behandlingsm&aring;let er i det lange l&oslash;b hjemmeblodtryk &lt;130/80 mmHg, og fors&oslash;ges n&aring;et i l&oslash;bet af 3-6 m&aring;neder</li>
</ul>
<h4><a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/75020">Statiner</a></h4>
<ul>
    <li>Der vil ofte v&aelig;re indikation for statin hos patienter, hvor man starter antihypertensiv behandling, idet det er patientens absolutte risiko, der er indikationen for behandling af hypertension</li>
</ul>
<h3>Anden behandling</h3>
<ul>
    <li>V&aelig;gtreduktion ved overv&aelig;gt kan give grundlag for reducerede medikamentdoser</li>
    <li>V&aelig;gtreduktion ved overv&aelig;gt giver gunstig virkning p&aring; flere risikofaktorer</li>
</ul>
<h3>Antitrombotisk behandling</h3>
<ul>
    <li>[DliActiveSubstance;5022;Acetylsalicylsyre]&nbsp;har en dokumenteret forebyggende p&aring; nye events hos patienter med kardiovaskul&aelig;r sygdom</li>
    <li>Hos patienter uden kardiovaskul&aelig;r sygdom anbefales acetylsalicylsyre ikke i dag</li>
    <li>Hos patienter med diabetes mellitus uden kardiovaskul&aelig;r sygdom kan&nbsp;[DliActiveSubstance;5022;acetylsalicylsyre]&nbsp;overvejes ved h&oslash;j risiko for isk&aelig;misk hjertesygdom (moderat til sv&aelig;r albuminuri eller flere risikofaktorer som fx rygning og arvelig disposition)</li>
</ul>
<h3>Kirurgi</h3>
<ul>
    <li>Ved sv&aelig;r hypertension b&oslash;r elektiv (ikke akut) operation uds&aelig;ttes indtil blodtrykss&aelig;nkende behandling er optimeret</li>
</ul>
<h3>Forebyggende behandling</h3>
<ul>
    <li>Sund livsstil</li>
</ul>
<h2>Henvisning</h2>
<ul>
    <li>Indl&aelig;ggelse som &oslash;jeblikkelig hj&aelig;lp ved
    <ul>
        <li>Hypertensiv krise, dvs. alvorlig hypertension med akut opst&aring;ede neurologiske eller kardiale symptomer</li>
        <li>Vanskelig regulerbart blodtryk og samtidig alvorlige komplikationer, fx hjertesvigt, koronare eller cerebrale symptomer</li>
        <li>Graviditet med pr&aelig;eklampsi eller eklampsi</li>
    </ul>
    </li>
    <li>Ved mistanke om sekund&aelig;r hypertension</li>
    <li>Ved malign/hurtigt accelererende hypertension</li>
    <li>Ved behandlingsresistent hypertension (BT h&oslash;jt trods behandling), is&aelig;r hos yngre patienter eller ved meget h&oslash;jt blodtryk (over 180/110)</li>
    <li>Konferer med intern mediciner ved s&aelig;rlig h&oslash;je blodtryk, fx
    <ul>
        <li>Over 220-250 mmHg systolisk eller</li>
        <li>Over 125-130 mmHg diastolisk</li>
    </ul>
    </li>
</ul>
<h2>Opf&oslash;lgning</h2>
<h3>Plan</h3>
<ul>
    <li>I startfasen af mild (grad 1) hypertension
    <ul>
        <li>Anbefales kontroller med 4-6 ugers interval, vent om muligt med introduktion af medikament til efter ca. 3-6 m&aring;neders observationstid. Dette afh&aelig;nger is&aelig;r af den samlede risiko</li>
        <li>Interventionen er i starten prim&aelig;rt &oslash;get fysisk aktivitet, kost&aelig;ndringer og evt. v&aelig;gtreduktion</li>
        <li>Hos diabetikere og patienter med nyresygdom startes straks op med behandling</li>
    </ul>
    </li>
    <li>Efter stabilisering
    <ul>
        <li>Som regel er 2-3 kontroller pr. &aring;r tilstr&aelig;kkeligt, men det afh&aelig;nger af blodtrykket, eventuelle komplikationer og samlet risiko</li>
        <li>Et studie har vist lige gode resultater med kontroller hver 6. m&aring;ned versus hver 3. m&aring;ned</li>
    </ul>
    </li>
    <li>Ved grad 2 og 3 hypertension hyppigere kontroller (initialt med 2-4 ugers interval, men derefter som for grad 1 hypertension)</li>
    <li>De fleste placebokontrollerede studier af blodtryksbehandling, hvor der er vist gavnlig effekt p&aring; h&aring;rde endepunkter, har haft et blodtryk p&aring; 150-180/90 mmHg som behandlingsresultat
    <ul>
        <li>Ved hypertension er behandlingsm&aring;let generelt hjemmeblodtryk p&aring; 120-135/70-85 mmHg, ved kendt hjerte-kar-sygdom, nyresygdom eller diabetes er behandlingsm&aring;let 120-130/70-80 mmHg</li>
    </ul>
    </li>
</ul>
<h4>Egenkontrol</h4>
<ul>
    <li>Brug af valideret elektronisk m&aring;leapparatur giver &oslash;gede muligheder for, at patienten selv kan kontrollere blodtrykket</li>
    <li>En systematisk oversigt konkluderer, at effektiv opf&oslash;lgning af patienter med hypertension kr&aelig;ver rigor&oslash;s h&aring;ndtering med regelm&aelig;ssige kontroller og villighed til at intensivere medikamentbehandlingen</li>
    <li>En alternativ l&oslash;sning, som bevarer l&aelig;gens kontrol med behandlingen, er at lade patienten m&aring;le blodtrykket selv hos l&aelig;gen uden, at l&aelig;gen er i rummet</li>
</ul>
<h4>Web-baseret kontrol med egenm&aring;ling?</h4>
<ul>
    <li>Antallet af patienter som opn&aring;ede m&aring;ls&aelig;tning (BT &lt;140/90) var signifikant bedre i en gruppe, som blev h&aring;ndteret med egenm&aring;ling, web-rapportering og tilbagemelding fra en farmaceut, sammenlignet med tilsvarende m&aring;ling uden web-baseret tilbagemelding, eller sammenlignet med vanlig blodtrykskontrol hos l&aelig;gen
    <ul>
        <li>56 % opn&aring;ede m&aring;l-tryk i egenm&aring;ling/tilbagemeldingsgruppen, hhv. 36 og 31 % i de 2 andre grupper</li>
        <li>M&aring;ske kan dette &aring;bne nye muligheder for bedring af blodtryksbehandlingen</li>
    </ul>
    </li>
</ul>
<h3>Hvad b&oslash;r man kontrollere</h3>
<h4>Generelt</h4>
<ol>
    <li>Hvordan har patienten det?</li>
    <li>Er blodtrykket tilfredsstillende?</li>
    <li>G&oslash;r patienten nok for at reducere sin totale absolutte kardiovaskul&aelig;re risiko?</li>
    <li>Tager patienten medikamenter som foreskrevet?</li>
    <li>Foreligger der medikamentelle bivirkninger? Kan de evt. accepteres?</li>
    <li>Har patienten udviklet (andre) sygdomme i hjerte- og karsystemet?</li>
</ol>
<h4>I opstartsfasen</h4>
<ul>
    <li>Kontrol hver 3.-4. uge i 3-6 m&aring;neder. Anamnestisk gennemgang af
    <ul>
        <li>Fysisk aktivitet</li>
        <li>Kost</li>
        <li>V&aelig;gt</li>
        <li>Sp&oslash;rg om bivirkninger</li>
    </ul>
    </li>
</ul>
<h4>Laboratoriepr&oslash;ver</h4>
<ul>
    <li>Vil til en vis grad v&aelig;re afh&aelig;ngig af komorbiditet, medikamentklasse og dosering</li>
    <li>Ved opstart af behandlingen
    <ul>
        <li>Kalium, natrium, HbA1c, lipider, urat, kreatinin, urinstix, kvantiter mikroalbumin ved negativ p&aring; vanlig stix</li>
        <li>Kontroller elektrolytter (K<sup>+</sup>) og urinsyre ca. 3 m&aring;neder efter behandlingsstart med diuretika</li>
        <li>Kontroller lipider, glukose,&nbsp;HbA1c og kalium ca. 3 m&aring;neder efter behandlingsstart med betablokkere eller tiazider</li>
        <li>Kontroller kreatinin 1 m&aring;ned efter opstart af&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/96500">ACE-h&aelig;mmer</a>&nbsp;og&nbsp;<a href="http://pro.medicin.dk/Laegemiddelgrupper/Grupper/97038">AII-h&aelig;mmer</a>&nbsp;hos &aelig;ldre, og ved kendt hjerte-kar-sygdom</li>
    </ul>
    </li>
    <li>&Aring;rlig kontrol af kalium, natrium, urinsyre, lipider, HbA1c, kreatinin, mikroalbuminuri og v&aelig;gt</li>
    <li>Unormale pr&oslash;ver b&oslash;r kontrolleres oftere</li>
</ul>
<h2>Sygdomsforl&oslash;b, komplikationer og prognose</h2>
<h3>Sygdomsforl&oslash;b</h3>
<ul>
    <li>En h&oslash;j andel af de patienter der bruger medicin mod hypertension, har ved kontrol fortsat h&oslash;jt blodtryk</li>
    <li>Medikamentel blodtryksbehandling har vist st&oslash;rst relativ virkning p&aring; risikoen for apopleksi, mindre p&aring; risikoen for isk&aelig;misk hjertesygdom</li>
    <li>Behandlingen er oftest livslang, hvilket det er vigtigt at informere patienten om</li>
</ul>
<h3>Komplikationer</h3>
<ul>
    <li>Cerebrovaskul&aelig;r sygdom
    <ul>
        <li><a href="~/link.aspx?_id=94012BB2FA994D54AB6E15EED95449BB&amp;_z=z">TIA, apopleksi</a>, vaskul&aelig;r demens</li>
    </ul>
    </li>
    <li>Isk&aelig;misk hjertesygdom
    <ul>
        <li><a href="~/link.aspx?_id=133E5B4491494DFFB4C386C66990345C&amp;_z=z">Angina pectoris</a>&nbsp;og&nbsp;<a href="~/link.aspx?_id=74939EBF4A694B359A96B1E33A94FC50&amp;_z=z">hjerteinfarkt</a></li>
    </ul>
    </li>
    <li><a href="~/link.aspx?_id=3EA9AFEB17F04EE2876045A9FB53DBDC&amp;_z=z">Hjertesvigt</a></li>
    <li>Anden blodtryksrelateret hjertesygdom
    <ul>
        <li>Venstre ventrikel hypertrofi med associeret diastolisk dysfunktion, venstre ventrikel-dilatation og hjertesvigt, disponerer for pludselig d&oslash;d</li>
        <li>Pludselig hjerted&oslash;d udg&oslash;r 10-20 % af alle d&oslash;dsfald i den vestlige verden</li>
        <li>Hypertensiv hjertesygdom er en hyppig &aring;rsag til atrieflimren&nbsp;<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
    </ul>
    </li>
    <li>Perifer arteriel sygdom</li>
    <li>Nyreskade</li>
    <li><a href="~/link.aspx?_id=2EFE6C2B857444C185EB97BA7ED7BFA9&amp;_z=z">Retinasygdom</a></li>
</ul>
<h3>Prognose</h3>
<ul>
    <li>Ubehandlet h&oslash;jt blodtryk giver &oslash;get risiko for hjerte-kar-sygdomme og d&oslash;d</li>
    <li>Prognosen er st&aelig;rkt afh&aelig;ngig af, hvor h&oslash;jt blodtrykket er, varighed af hypertension, og hvilke andre risikofaktorer der foreligger</li>
    <li>Absolut risikoreduktion ved ad&aelig;kvat behandling har i bedste fald i studier (&aelig;ldre studier) vist sig at v&aelig;re ca. 1,4 % for apopleksi og 1,5 % for total d&oslash;d pr. &aring;r</li>
</ul>
<h2>Baggrundsoplysninger &nbsp;&nbsp;</h2>
<h3>Afgr&aelig;nsning </h3>
<ul>
    <li>Hypertension medf&oslash;rer betydelig &oslash;get risiko for kardiovaskul&aelig;r sygdom, f&oslash;rst og fremmest apopleksi og isk&aelig;misk hjertesygdom. Desuden kan hypertension medf&oslash;re p&aring;virkning af nyrerne. Det er vist, at behandling reducerer risikoen for komplikationer<a href="%20" title="Messerli FH, Williams B, Ritz E, Essential hypertension. Lancet 2007;370: 591-603" data-url="reference-link" data-value="Messerli FH, Williams B, Ritz E, Essential hypertension. Lancet 2007;370: 591-603" data-type="journal-reference" data-value-piped="Messerli FH, Williams B, Ritz E|Essential hypertension|Lancet|2007|370|591-603"><sup>1</sup></a></li>
    <li>Gr&aelig;nsen mellem normalt og forh&oslash;jet blodtryk er ikke skarp. Hypertension er defineret ud fra vedtagne blodtryksgr&aelig;nser, mens behandlingskr&aelig;vende hypertension afgr&aelig;nses ud fra tilg&aelig;ngelig evidens samt en vurdering af risiko og forventet gevinst af behandling<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a>&nbsp;</li>
    <li>Hypertension foreligger n&aring;r hjemme- eller dagtidsdelen af d&oslash;gnblodtrykket er p&aring; eller over 135 mmHg systolisk og/eller 85 mmHg diastolisk. Denne definition p&aring; hypertension g&aelig;lder uanset patientens alder, hvorimod behandlingsindikationen som tidligere beskrevet vil v&aelig;re afh&aelig;nging af patientens alder og forventet gevinst ved behandling, som igen er afh&aelig;ngig af, om patienten har hjerte-kar-sygdom&nbsp;eller patientens risiko for at udvikle hjerte-kar-sygdom.&nbsp;<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
    <li>Ved kendt hjerte-kar-sygdom, nyresygdom og diabetes betragtes et vedvarende hjemmeblodtryk&nbsp;over 130/80 mmHg som behandlingskr&aelig;vende&nbsp;<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
    <li>Ved de letteste grader af mild hypertension (grad 1 hypertension, systolisk hjemmeblodtryk 135-154 mmHg, diastolisk BT 85-94 mmHg) b&oslash;r opstart af medicinsk behandling afh&aelig;nge af patientens samlede kardiovaskul&aelig;re risikoprofil og livstidsrisiko</li>
    <li>Essentiel hypertension, der udg&oslash;r 95-99 % af tilf&aelig;lde, er uden kendt &aring;rsag</li>
</ul>
<h3>Forekomst</h3>
<ul>
    <li>Pr&aelig;valens
    <ul>
        <li>I en dansk befolkningsunders&oslash;gelse p&aring; Fyn af 7767 mennesker i alderen 20-89 &aring;r udf&oslash;rt i 2004-2006 fandtes med brug af b&aring;de klinik- og hjemmeblodtryk en alderskorrigeret pr&aelig;valens af hypertension p&aring; 25,7 % bed&oslash;mt p&aring; klinikblodtryk, og 22,3 % bed&oslash;mt ved hjemmeblodtryk. Pr&aelig;valensen steg med alderen fra 1 % blandt de 20-29-&aring;rige til 69 % blandt de 80-89-&aring;rige. Det kan konkluderes svarende til udenlandske unders&oslash;gelser, at 20-25 % af den voksne befolkning har hypertension
        <p><img style="width: 200px; height: 149px;" alt="Figuren viser prævalensen af hypertension med stigende alder i en dansk befolkningsundersøgelse" src="913EF86142694A5DBAFED8531311A73B-200-149" text="Figuren viser prævalensen af hypertension med stigende alder i en dansk befolkningsundersøgelse" title="Prævalens af hypertension med stigende alder i en dansk befolkningsundersøgelse" longdesc="Figuren viser prævalensen af hypertension med stigende alder i en dansk befolkningsundersøgelse" height="149" width="200"><br>
        <sup><strong>Figur 1</strong>: Pr&aelig;valensen af hypertension med stigende alder i en dansk befolkningsunders&oslash;gelse<br>
        </sup></p>
        </li>
    </ul>
    </li>
    <li>Ikke optimal behandling
    <ul>
        <li>I den fynske befolkningsunders&oslash;gelse publiceret i 2009 fandt man, at ca. 70 % af hypertensionspatienterne kendte deres diagnose, og ca. 60 % var i behandling. Bed&oslash;mt ved klinikblodtryk var ca. 60 % velbehandlede, bed&oslash;mt ved hjemmeblodtryk var ca. 75 % velbehandlede</li>
        <li>I en anden dansk unders&oslash;gelse af 5413 hypertensive patienter behandlet i almen praksis fandt man, at kun 29,1 % n&aring;ede optimal blodtrykskontrol. En stor del af patienterne var kun i behandling med et eller to antihypertensiva. Blandt diabetikere med hypertension var 17,7 % ikke i behandling med en ACE-h&aelig;mmer eller en angiotensin II-antagonist</li>
    </ul>
    </li>
</ul>
<h3>&AElig;tiologi og patogenese</h3>
<ul>
    <li>Hos 95-99 % finder man ingen enkelt&aring;rsag til hypertension, dvs. patienten har essentiel (prim&aelig;r) hypertension
    <ul>
        <li>Famili&aelig;r pr&aelig;disposition &oslash;ger risikoen<a href=" " data-type="journal-reference" data-value="Luft FC, Twins in cardiovascular genetic research. Hypertension 2001;37: 350-6" data-value-piped="Luft FC|Twins in cardiovascular genetic research.|Hypertension|2001|37|350-6|11230299" data-url="reference-link" data-pubmedid="11230299" title="Luft FC, Twins in cardiovascular genetic research. Hypertension 2001;37: 350-6"><sup>25</sup></a></li>
        <li>Livsstil kan disponere</li>
    </ul>
    </li>
    <li>Hos ca. 1-5 % kan man p&aring;vise en &aring;rsag til hypertensionen, dvs. patienten har sekund&aelig;r hypertension
    <ul>
        <li>Renal hypertension (nyresygdom) er den hyppigste &aring;rsag til sekund&aelig;r hypertension </li>
        <li>De &oslash;vrige &aring;rsager til sekund&aelig;r hypertension er mere sj&aelig;ldne:
        <ul>
            <li>Renovaskul&aelig;r hypertension pga. <a href="~/link.aspx?_id=475B02E2791F434E82F014B0FA9AF742&amp;_z=z">nyrearteriestenose </a></li>
            <li>Binyrebarkadenom (<a href="~/link.aspx?_id=89663821D6064AF3A3FF71C07551B84F&amp;_z=z">Conns syndrom</a>)
            <ul>
                <li>Aldosteronmedieret hypertension </li>
                <li>Det er kontroversielt, hvor hyppig aldosteronmedieret hypertension er</li>
            </ul>
            </li>
        </ul>
        </li>
        <li><a href="~/link.aspx?_id=F591CCE49F43450D9529B1595BEBC734&amp;_z=z">F&aelig;okromocytom</a> </li>
        <li>Aortakoarktation</li>
    </ul>
    </li>
</ul>
<h4>Patofysiologi - nyrernes rolle, natrium- og v&aelig;ske-balance </h4>
<ul>
    <li>Ved essentiel hypertension er nyrefunktionen normal </li>
    <li>Renin-angiotensinsystemets komponenter har samme koncentration/aktivitet som hos normotensive </li>
    <li>Trods disse forhold menes nyrerne at spille en central rolle i patofysiologien ved essentiel hypertension, idet man mener, at nyrerne kr&aelig;ver et h&oslash;jere blodtryk end normalt for at opretholde en normal natriumbalance og et normalt ekstracellul&aelig;rvolumen</li>
</ul>
<h4>Patofysiologi - mikrovaskul&aelig;re og makrovaskul&aelig;re mekanismer</h4>
<ul>
    <li>&Oslash;get perifer arteriel karmodstand og normalt hjerteminutvolumen er karakteristisk for essentiel hypertension </li>
    <li>Modstandskarrene har hos hypertensive reduceret lumen </li>
    <li>Isoleret systolisk hypertension hos &aelig;ldre er en separat sygdomsgruppe, som skyldes &oslash;get stivhed i de st&oslash;rre arterier med stigende alder</li>
</ul>
<h4>Blodtryksv&aelig;rdier og kardiovaskul&aelig;r risiko </h4>
<ul>
    <li>De fleste epidemiologer er enige om, at relationen mellem risikoen for kardiovaskul&aelig;r sygdom og blodtrykket er kontinuerlig uden nogen t&aelig;rskelv&aelig;rdi, hvor risikoen for kardiovaskul&aelig;re komplikationer pludselig &oslash;ges </li>
    <li>Derfor er behandlingskr&aelig;vende hypertension defineret ud fra tilg&aelig;ngelig evidens, en samlet vurdering af risiko og forventet gevinst af behandlingen, samt tilstedev&aelig;relse af evt. comorbiditet<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
    <li>Risikoen estimeres p&aring; baggrund af risikofaktorer, hypertensive organskader, anden sygdom (fx kardiovaskul&aelig;r sygdom og diabetes mellitus) og graden af blodtryksforh&oslash;jelsen&nbsp;<a href=" " data-type="journal-reference" data-value="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: " data-value-piped="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:|2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH).|J Hypertens|2023|||37345492" data-url="reference-link" data-pubmedid="37345492" title="Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, Azizi M, Benetos A, Borghi C, Hitij JB, Cifkova R, Coca A, Cornelissen V, Cruickshank K, Cunha PG, Danser AHJ, de Pinho RM, Delles C, Dominiczak AF, Dorobantu M, Doumas M, Fernández-Alfonso MS, Halimi JM, Járai Z, Jelaković B, Jordan J, Kuznetsova T, Laurent S, Lovic D, Lurbe E, Mahfoud F, Manolis A, Miglinas M, Narkiewicz K, Niiranen T, Palatini P, Parati G, Pathak A, Persu A, Polonia J, Redon J, Sarafidis P, Schmieder R, Spronck B, Stabouli S, Stergiou G, Taddei S, Thomopoulos C, Tomaszewski M, Van de Borne P, Wanner C, Weber T, Williams B, Zhang ZY, Kjeldsen SE, Authors/Task Force Members:, 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens 2023;: "><sup>3</sup></a></li>
    <li>Framingham-studiet har vist, at systolisk blodtryk og pulstryk er de bedste pr&aelig;diktorer for udvikling af kardiovaskul&aelig;r sygdom efter 50-&aring;rs alderen. Pulstryk bruges dog ikke i den daglige klinik</li>
</ul>
<h3>Disponerende faktorer</h3>
<ul>
    <li>Arv, overv&aelig;gt, stort alkoholforbrug, i nogle tilf&aelig;lde stor saltindtagelse </li>
    <li>Fysisk inaktivitet </li>
    <li>Stress?
    <ul>
        <li>Jobstress havde if&oslash;lge et stort opf&oslash;lgningsstudie lille eller ingen effekt p&aring; blodtrykket</li>
    </ul>
    </li>
    <li>Eftersom totalrisiko er vigtig for h&aring;ndteringen af disse patienter, b&oslash;r man vurdere de risikofaktorer, som indg&aring;r i det metaboliske kardiovaskul&aelig;re syndrom:</li>
</ul>
<h4>Faktorer i det metaboliske syndrom som er mest relevante i almen praksis</h4>
<ul>
    <li>Hypertension </li>
    <li>Dyslipid&aelig;mier, oftest med lav HDL-kolesterol og forh&oslash;jede triglycerider </li>
    <li>Type 2-diabetes mellitus eller nedsat glukosetolerans </li>
    <li>Abdominal fedme</li>
</ul>
<h3>ICPC-2</h3>
<p>[ICPC]</p>
<h3>ICD-10/SKS-koder</h3>
<p>[ICD10]</p>
<h2>Patientinformation</h2>
<h3>Hvad du b&oslash;r informere patienten om</h3>
<ul>
    <li>H&oslash;jt blodtryk giver i de fleste tilf&aelig;lde ikke symptomer</li>
    <li>Det er vigtigt at reducere totalrisikoen for hjerte-kar-sygdom, ikke bare blodtrykket</li>
    <li>Medicin kan ikke erstatte sunde levevaner</li>
    <li>En beregning af kardiovaskul&aelig;r totalrisiko, yde r&aring;dgivning, give vejledning og klare anbefalinger. Det er is&aelig;r vigtigt at diskutere eventuelle modforestillinger eller skepsis overfor behandling med patienten</li>
    <li>Det er patienten som m&aring; afg&oslash;re, om og p&aring; hvilken m&aring;de vedkommende kan reducere sin risiko</li>
    <li><a href="https://vejledninger.dsam.dk/hjerte/?mode=visKapitel&amp;cid=1062&amp;gotoChapter=1062">DSAM's vejledning for isk&aelig;misk-hjerte-kar-sygdom, risikovurdering</a></li>
</ul>
<h4>Medikamentel behandling</h4>
<ul>
    <li>Beslutningen b&oslash;r ideelt set baseres p&aring;, at patienten er informeret om effekten af behandling, fx i form af absolut risikoreduktion (ARR) eller NNT (number needed to treat to prevent an event) som er 1/ARR x 30 % (forventet behandlingsresultat)</li>
</ul>
<h3>Underst&oslash;ttende behandlingsvejledninger</h3>
<ul>
    <li><a href="https://www.nice.org.uk/guidance/cg127" target="_self">NICE behandlingsvejledning fra 2011, opdateret 2016</a>&nbsp;</li>
    <li><a href="https://nbv.cardio.dk/hypertension">Dansk Cardiologisk Selskabs behandlingsvejledning 2018 (opdateret 2024)</a></li>
    <li><a rel="noopener noreferrer" href="https://www.dahs.dk/fileadmin/user_upload/2013_opdateringer/opdateringer_2014/opdateringer_2015/behandlingsvejledning_2015_juni_final.pdf" target="_blank">Dansk Hypertensionsselskabs behandlingsvejledning fra 2015</a></li>
    <li>DSAM vejledning:&nbsp;<a href="https://vejledninger.dsam.dk/hjerte/?mode=visKapitel&amp;cid=1066&amp;gotoChapter=1066">Isk&aelig;misk hjerte-kar-sygdom: Forebyggelse, udredning og behandling ved hypertension</a></li>
</ul>
<h3>Hvad findes af skriftlig information</h3>
<ul>
    <li><a href="~/link.aspx?_id=87A63D3F59B04E5E9A17697238E5811C&amp;_z=z">Metabolisk syndrom</a></li>
</ul>
<h4>Hypertension</h4>
<ul>
    <li><a href="~/link.aspx?_id=3321C0D0D0CE409B8EDC6EBBC733CD1F&amp;_z=z">Hypertension, oversigt</a></li>
    <li><a href="~/link.aspx?_id=6787B7053479413B8F612E58E31A6118&amp;_z=z">Hypertension, &aring;rsager</a></li>
    <li><a href="~/link.aspx?_id=C21A5B96472844FCB41FC63A01E51D94&amp;_z=z">Hypertension, symptomer</a></li>
    <li><a href="~/link.aspx?_id=B9CB0B6385EE4D33A8EFDD00052428EB&amp;_z=z">Hypertension, udredning</a></li>
    <li><a href="~/link.aspx?_id=0C3C6CE2646144A1BF105BE743E0272E&amp;_z=z">Hypertension, egenbehandling</a></li>
    <li><a href="~/link.aspx?_id=67E13A750630453BB0C896EBF14B8820&amp;_z=z">Hypertension, medikamentel behandling</a></li>
    <li><a href="~/link.aspx?_id=84ADB9E093A949578275C244737CE2F8&amp;_z=z">Hypertension, komplikationer</a></li>
    <li><a href="~/link.aspx?_id=57194A9263BB4978B8AFE2F8881939CA&amp;_z=z">Hypertension, malign</a></li>
    <li><a href="~/link.aspx?_id=1E5ABA7424C24DE9BE7D930E0CBDBF63&amp;_z=z">Hypertension, &oslash;jenskader</a></li>
    <li><a href="https://aktivsundhed.dk/da/fysisk-aktivitet/traening-som-behandling/26-hypertension">Center for Aktiv Sundhed, Tr&aelig;ning som behandling, Hypertension</a></li>
    <li><a href="https://www.sst.dk/da/udgivelser/2018/Forebyggelsespakke-Fysisk-aktivitet">Forebyggelsespakke - Fysisk aktivitet, Sundhedsstyrelsen, 2023</a></li>
</ul>
<h4>Egenbehandling, relevant information</h4>
<ul>
    <li><a href="~/link.aspx?_id=E25FF48511C54312A77EBB9791D68C7E&amp;_z=z">Kostr&aring;d til patienter med h&oslash;jt kolesterol</a></li>
    <li><a href="~/link.aspx?_id=FBBA288054CA4266885A0433723F8751&amp;_z=z">Information om sund kost</a></li>
    <li><a href="~/link.aspx?_id=1E33339A3877446C86E74A4809F2DA4C&amp;_z=z">Fedtfattig mad</a></li>
    <li><a href="~/link.aspx?_id=527D40A06CDC4A69BC402CEDDB3D5A2A&amp;_z=z">Kostfibre</a></li>
    <li><a href="~/link.aspx?_id=7DA93580EDFF4B708A030DFD510826C3&amp;_z=z">Di&aelig;t og tr&aelig;ning - en sund balance for et sundt hjerte</a></li>
    <li><a href="~/link.aspx?_id=59B290643CEE4D2B93E196CC06852789&amp;_z=z">Information om homocystein</a></li>
    <li><a href="~/link.aspx?_id=612971DED73A413380BE9CD8C017D3C9&amp;_z=z">Rygestop -hvorfor og hvordan</a></li>
    <li><a href="~/link.aspx?_id=06BBC660393C4078AD8F93C26F079F87&amp;_z=z">EKG</a>&nbsp;</li>
</ul>
<h4>Overv&aelig;gt og slankning</h4>
<ul>
    <li><a href="~/link.aspx?_id=85C1F015AAA144ECB4F6BBC2313DD03F&amp;_z=z">Overv&aelig;gt, hvad er det?</a></li>
    <li><a href="~/link.aspx?_id=ADEA7888913F4DAC979ABB07E8EAF3E9&amp;_z=z">Overv&aelig;gt og kost - bliv m&aelig;t</a></li>
    <li><a href="~/link.aspx?_id=5DFF90B86D16496DA1883D5EEE015E28&amp;_z=z">Overv&aelig;gt og kost - mad i l&oslash;bet af dagen</a></li>
    <li><a href="~/link.aspx?_id=47E3BDE94CB54F46956BA9292E1DD7A1&amp;_z=z">Overv&aelig;gt og fedme, fysisk aktivitet</a></li>
    <li><a href="~/link.aspx?_id=A75B0876AA8E437CB14F184AAA30E6FA&amp;_z=z">Overv&aelig;gt og kost - n&aring;r du skal ud at spise</a></li>
</ul>
<h3>Animationer og tegninger</h3>
<ul>
    <li><a href="~/link.aspx?_id=EEE771668B304DBCAB47BF7ECA409EEE&amp;_z=z">Hvordan arbejder hjertet</a></li>
    <li><a href="~/link.aspx?_id=E97223C3010242A189248C4406BA7804&amp;_z=z">Blodtrykket</a></li>
    <li><a href="~/link.aspx?_id=8524B86163324CAF97BFDC9C8DDAC4BB&amp;_z=z">Hvorn&aring;r er blodtrykket for h&oslash;jt?</a>&nbsp;- oversigtstegning</li>
</ul>
<h3>Patientorganisationer</h3>
<ul>
    <li><a href="http://www.hjerteforeningen.dk/">Hjerteforeningen</a></li>
    <li><a href="http://www.hjernesagen.dk/">Hjernesagen</a></li>
</ul>
<h2>Link til vejledninger</h2>
<ul>
    <li><a href="https://nbv.cardio.dk/hypertension">Dansk Cardiologisk Selskabs nationale behandlingsvejledning 2024</a></li>
    <li>DSAM vejledning:&nbsp;<a href="https://vejledninger.dsam.dk/hjerte/?mode=visKapitel&amp;cid=1066&amp;gotoChapter=1066">Isk&aelig;misk hjerte-kar-sygdom: Forebyggelse, udredning og behandling ved hypertension</a></li>
    <li>DSAM vejledning: <a href="https://vejledninger.dsam.dk/hjerte/?mode=visKapitel&amp;cid=1063&amp;gotoChapter=1063#chapter_1063">Isk&aelig;misk hjerte-kar-sygdom: Hjertevenlige kostvaner</a></li>
    <li>DSAM vejledning: <a href="https://vejledninger.dsam.dk/hjerte/?mode=visKapitel&amp;cid=1062&amp;gotoChapter=1062">Isk&aelig;misk hjerte-kar-sygdom: Risikovurdering og score</a></li>
    <li>Forl&oslash;bsbeskrivelser og pakkeforl&oslash;b [ICPC]</li>
</ul>
<h2>Illustrationer </h2>
<h3>Billeder</h3>
<ul>
    <li><a href="~/link.aspx?_id=B2ACAE2DE5BB4DFCA78E8B6AA18DB054&amp;_z=z">Nyrearteriestenose, kontrastr&oslash;ntgen, ballondilateret</a></li>
</ul>
<h3>Video</h3>
<ul>
    <li><a href="~/link.aspx?_id=2E62CC247CED44B5AFA692FB6C2F8E21&amp;_z=z">Belastnings-ekg</a></li>
    <li><a href="~/link.aspx?_id=B5D5FD2618B74FF4B24B65AFC5A8647B&amp;_z=z">Hjertekateterisering</a> </li>
    <li><a href="~/link.aspx?_id=65404E2586DC42CD8B9337A2E037FC36&amp;_z=z">Trans&oslash;sofageal ekko</a> </li>
</ul>
<h2>Undervisning</h2>
<ul>
    <li><a href="~/link.aspx?_id=B19634C01A544D1B8B9FB32A37E27758&amp;_z=z">Om h&oslash;jt blodtryk</a></li>
    <li><a href="~/link.aspx?_id=689A8398333048988BCCA08972802B86&amp;_z=z">Om hypertension</a> </li>
    <li><a href="~/link.aspx?_id=5609AE5DB88B4F8381F1807F9EE755FD&amp;_z=z">Om hyperlipid&aelig;mi</a></li>
    <li><a href="~/link.aspx?_id=32BC9B29A2634109A43ED5C849C9BDA7&amp;_z=z">Om kost</a></li>
</ul>]]></HtmlField>
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<h3>Diagnose</h3>
<ul>
    <li>Stilles p&aring; basis af tre-d&oslash;gns hjemmeblodtryks- eller 24-timers d&oslash;gnblodtryksm&aring;ling&nbsp;&nbsp;</li>
    <li>Hjemmeblodtryk b&oslash;r hver gang m&aring;les 3 gange efter 5 minutters siddende hvile med et valideret blodtryksapparat</li>
    <li>Patientens samlede risiko for udvikling af hjerte-kar-sygdom opg&oslash;res ved at afd&aelig;kke andre risikofaktorer, hypertensive subkliniske organskader og anden relevant sygdom</li>
</ul>
<h3>Behandling</h3>
<ul>
    <li>Ved mild hypertension (hjemmeblodtryk 135-154/85-94 mmHg) og lav-moderat risiko for hjerte-kar-sygdom&nbsp;p&aring;begyndes livstils&aelig;ndringer og blodtryk observeres i 3-6 mdr. Ved fortsat hypertension p&aring;begyndes medicinsk blodtrykss&aelig;nkende behandling&nbsp;</li>
    <li>Ved moderat-sv&aelig;r hypertension (hjemmeblodtryk &gt;=155/95 mmHg) p&aring;begyndes livstils&aelig;ndringer og medicinsk blodtrykss&aelig;nkende behandling samtidigt</li>
    <li>Behandlingsm&aring;l er 120-135/70-85 mmHg for patienter 18-80 &aring;r og 130-145 mmHg for patienter &aelig;ldre end 80 &aring;r</li>
</ul>
<h3>Henvisning</h3>
<ul>
    <li>Indl&aelig;ggelse ved
    <ul>
        <li>Hypertensiv krise</li>
        <li>Vanskelig regulerbart blodtryk og samtidig alvorlige komplikationer</li>
        <li>Graviditet med pr&aelig;eklampsi eller eklampsi</li>
    </ul>
    </li>
    <li>Henvisning til ambulant udredning
    <ul>
        <li>Ved mistanke om sekund&aelig;r hypertension</li>
        <li>Ved behandlingsresistent hypertension</li>
    </ul>
    </li>
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