p.81 抽出テキスト

Recommendations for pharmacological low-density lipoprotein cholesterol lowering for those <70 years of age It is recommended that a high-intensity statin is prescribed up to the highest tolerated dose to reach the LDL-C goals set for the specific risk group. I A In patients with established ASCVD, lipid-lowering treatment with an ultimate LDL-C goal of <1.4 mmol/L (55 mg/dL) and a >_50% reduction in LDL-C vs. baseline is recommended. I A If the goals are not achieved with the maximum tolerated dose of a statin, combination with ezetimibe is recommended. I B For secondary prevention patients not achieving their goals on a maximum tolerated dose of a statin and ezetimibe, combination therapy including a PCSK9 inhibitor is recommended. I A For very-high-risk FH patients (that is, with ASCVD or with another major risk factor) who do not achieve their goals on a maximum tolerated dose of a statin and ezetimibe, combination therapy including a PCSK9 inhibitor is recommended. I C Statin therapy is not recommended in premenopausal female patients who are considering pregnancy or are not using adequate contraception. III C Recommendation for drug treatments of patients with hypertriglyceridaemia Statin treatment is recommended as the first drug of choice for reducing CVD risk in high-risk individuals with hypertriglyceridaemia [triglycerides >2.3 mmol/L (200 mg/dL)]. I A Recommendations for the treatment of dyslipidaemias in older people (70 years) Treatment with statins is recommended for older people with ASCVD in the same way as for younger patients. I A It is recommended that the statin is started at a low dose if there is significant renal impairment and/or the potential for drug interactions. I C Recommendation for the treatment of dyslipidaemias in diabetes mellitus In patients with type 2 DM at very high risk (e.g. with established ASCVD and/or severe TOD) intensive lipid-lowering therapy, ultimately aiming at >_50% LDL-C reduction and an LDL-C of <1.4 mmol/L (55 mg/dL) is recommended. I A In patients with type 2 DM >40 years at high risk, lipid-lowering treatment with an ultimate LDL-C goal of >_50% LDL-C reduction and an LDL-C of <1.8 mmol/L (70 mg/dL) is recommended. I A Recommendations for lipid management in patients with moderate-to-severe chronic kidney disease (Kidney Disease Outcomes Quality Initiative stages 35) The use of statins or statin/ezetimibe combination is recommended in patients with non-dialysis-dependent, stage 35 CKD. I A In patients with dialysis-dependent CKD who are free of ASCVD, commencing statin therapy is not recommended. III A Recommendations for the clinical management of hypertension Classification of BP It is recommended that BP should be classified as optimal, normal, high-normal, or grades 13 hypertension, according to office BP. I C Diagnosis of hypertension It is recommended to base the diagnosis of hypertension on: • Repeated office BP measurements, on more than one visit, except when hypertension is severe (e.g. grade 3 and especially in high-risk patients) or I C

• Out-of-office BP measurement with ABPM and/or HBPM when feasible. I C

Assessment of HMOD To evaluate for the presence of HMOD, measurement of serum creatinine, eGFR, electrolytes, and ACR is recommended for all patients. A 12-lead ECG is recommended for all patients, and echocardiography is recommended for those with ECG abnormalities or signs/symptoms of LV dysfunction. Fundoscopy or retinal imaging is recommended for patients with grades 2 or 3 hypertension and all hypertensive patients with DM. I B Thresholds for initiation of drug treatment of hypertension For grade 1 hypertension, treatment initiation based on absolute CVD risk, estimated lifetime benefit, and the presence of HMOD is recommended. I C For patients with grade 2 hypertension or higher, drug treatment is recommended. I A Office BP treatment targets It is recommended that the first objective of treatment is to lower BP to <140/90 mmHg in all patients, and that subsequent BP targets are tailored to age and specific comorbidities. I A

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