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Riscul adiţional pentru persoanele cu hipertensiune arterială "&)%"ă, (+c)(+-.%,"'-+, '"/%.+"%,-',".'"",c+-+"c%,.,)c-+., +.).+",,c-(+".,,"'%.'ţc3ă,)+( '(3c<,=,/,c-(+"",, +",. ,> ,/ ,c-c+c ,,.d%"'"ă, c ,(+ c'%(+/ţ"'-ă. ,? ,/ ,"cd-.% ,3c!c+c-. ,@ ,/ ,cţ".'"% ,

c+"(/c,.%c+,,c.,+'c%,(',-"-."-0,

Screening<,1c&"'c+c,)().%cţ"",§',,(),,/"'ţ"+,c,.'",)c-(%( "",c'.&"-0,,

Screening-ul tensiunii arteriale<,)",-c+c,)+,(c'%(+,.,-',".',c+-+"c%ă,&c#(+c-ă,)+"',

1c&"'c+c,.'.",'.&ă+,&c+,,)+,(c',0,

Sindrom metabolic (SM)< )+3'ţc,c,-+","',"'",c-(+",,+",.,)+"'-+,c+,(d3"-c-c,,-"), cd(&"'c%., %"&"c,™,#.',c%-+c-ă.,`M,@=?<;:A,&&J .,JPN/(%,-+(%,,ă3.-, ş", !")+-+" %"+"&"0,

,

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,

:

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,

N0,RMT`QM,SQPQTMNĂ,

 

B.1. Nivelul instituţiilor de asistenţă medicală primară

 

P,+"+,

O(-"/%,

 

Rcş"",

 

=0,R+("%c1"c,)+"&c+ă,c,J`M,

T",.%,d(%"%(+,c+"(/c,.%c+,

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·

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P)",-c+c,)+(,c,

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Ðndreptarea la specialist ðn
cazul suspecţii de HTA
secundară
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,
4.1.
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c+"(/c,.%c+0,]>A_,
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Rezultatul va depinde de durata respectării recomandărilor şi intensitate. La unii pacienţi
efectul poate fi mai marcat decðt este indicat. ,
4.2.
Tratament medicamentos,
@0>0=0,`+c-c&'-.%,
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@0>0>0,`+c-c&'-.%,c-(+"%(+,

 

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·

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! A nu se indica pacienţilor hipertensivi cu vðrsta > 80 ani

:.,=;_,

@0>0@0,`+c-c&'-,c'-")%c!-c+,

 

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&"",*9A/=<<,& ;3"+,,-, "'"c-ă,§',-+c)"c, )c"'ţ"%(+,!")+-',"/",., +",,§'c%-,ş",(c+-,§'c%-,(c+,

c-.'",§',,-,+c%"3c-,

 

c+"(/c,.%c+ă,.'(,.-ă0,]=_,

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c%-+c-ă,%c, %.(3ă,,.'-,c-(+",

 

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A0,

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=8+.,*-cd%.%,?+,

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1",-'-,,+.)+c+,ş",

 

+(&c'ă+"%(+,

,)"c%"ş-"%(+,

,

B.2. Nivelul consultativ specializat (cardiolog)

P,+"+,

O(-"/%,

 

Rcş"",

=0,P"c '(,-",

=0=0,O('"+&c+c,MQŢ.,OOM,

`c-"c,,('."-ă,c, )c"'-.%.",!")+-',"/, ş", c% +c,-+c-c&'-.%.", &"c&'-(,,)"',, +c.%,,c-c+,c,(+ c'%(+, ţ"'-ă ş",,+",.%,

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ş",)+"3c+c,+",.%.",

 

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B.3. Nivelul de staţionar

 
 

P,+"+,

 

O(-"/%,

 

Rcş"",

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O('"ţ""%,%"'".,§',c+,,-,

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=>

 

',c+ă,,)"-c%"3c+c,

secţii profil terapeutic general, cardiologie (raional, municipal)

· J`M,"'(+"#cd"%ă,§', ('"ţ"",,c&d.%c-(+".,

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1c&"'c+,c)+(.'c-ă,

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c#.,-c+c,-+c-c&'-.%.".,.'(+", ),)c+.+,.%,&"'.-%(+,ş",

(+%(+.,.,.-"%"3c+c,&-(%(+,

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+c%"3c-,§',('"ţ"",,

c&d.%c-(+".,ş",',"-ă,

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· N(%",('(&"-'-, ,/+;c/c',c-,

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secţie cardiologie (nivel republican)

·

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· a%-+c,('( +c"c,c+(-""c'ă,

   

>P,.)%1,,

· R+(-"'.+"c,c'-"-c-"/ă,,

· K'"%, %3'ă/d+cţ,,

· Q1c&'.%,.',,(!",,

 

c3.+",,-,)(,"d"%ă,'.&c",§',

· `,-.%,,-(%+c'ţă,%c, %.(3ă,*că, %"&"c,™,

('"ţ"",,,-cţ"('c+0,

   

#.',@,A.8,&&(%;%,*=<<,

& ;%++,,

· O('"-(+"3c+c,`M,

 

c&d.%c-(+"",),>@,(+,

· O(',.%-cţ""%,,)"c%"ş-"%(+, *'.+(%( .,'+(%( ., '(+"'(%( ,-0+,

· K'/,-" cţ"",%c, +(&c'c+c,,)"c%"ş-"%(+,

>0>0,O('"+&c+c,J`M,

J`M,,.'c+ă,',"-ă,§',

Qd%" c-(+".<,

,.'c+,,.,)-c-,%c,

&c#(+"-c-c,c3.+"%(+,

·

O(',.%-cţ"c,,)"c%",-.%.", "',(&'".%,)c-(%( "",

,.,)-c-,c,",c.3c,J`M,

'"/%.+"%,)+'-,

-+c-c&'-.%,c.3%(+,)+"&c+,

]=?.,=@ ,"'-""c+c,ă+(+c, ',"-ă,§',c'.&"-,,"-.cţ"",

,)"-c%"3c+c,)c"'-.%.",ş",

T(&c'c-<,

.-"%"3c+c,+,.+,%(+,

· Q( +c",,

· `(&( +c",(&).-+"3c-ă=,,

,)"-c%"ş-"0,

 

· T3('c'ţă,&c '-"ă, '.%c+ă,,

· M+-+"( +c",,

 

=?

   

· ,.+c+c,!(+&('"%(+,§', )%c,&ă ş";,c.,.+"'ă,,

· K'/,-" cţ""%,+(&c'c-, ,,)"c%"ş-",

>0?0,O('"+&c+c,J`M,

J`M,+3",-'-ă,',"-ă,

! De atras atenţia la:

+3",-'-,.,/"'ţ"+c,

1c&"'c+,%"'"ă ş", )c+c%"'"ă,c)+(.'c-ă.,.,

.-"%"3c+c,&-(%(+,

c.3%(+,

· M+c+,,%cdă,%c,-+c-c&'-,,

· ,§',&(""c+c,,-"%.%.", ,/"cţă,,

· M)(+-,,&"c&'-,c+, +,,-',".'c,c+-+"c%ă,,

· M)'c,(d,-+.-"/ă,§',,(&',,

",)('"d"%,%c,'"/%,,

,-cţ"('c+0,M#.,-c+c,-+c)"",

&"c&'-(c,,(&d"'c-, "',?,ş",&c",&.%-,)+)c+c-, ',"-ă,"&)%"c+c, ,)"c%",-.%.",ş",,.)+c/ !+c, ,-+§',ă,)'-+.,)+/'"+c, (&)%"cţ""%(+,*+cţ""%(+,

c/+,+,)(,"d"%0,

· Oc.3,,.'c+,'%c-,,

· M-c+,,(+ c', "+/+,"d"%ă,,

· ‡'ă+c+,,/(%.&,,

?0,`+c-c&'-,

`c-"c,,('."-ă,c, )c"'-.%.",!")+-',"/, ş", c% +c,-+c-c&'-.%.", &"c&'-(,,)"',, +c.%,,c-c+,c,(+ c'%(+, ţ"'-ă ş",,+",.%,

· M#.,-c+c,-+c-c&'-.%.",%c, MQŢ ş",OOM,*-cd%%,

8.9.:+,

· M#.,-c+c,('."-", -+c).-",c,J`M, ,.'c+,§',.'ţ",,

c+"(/c,.%c+0,]=9.,>9.,>:_,,

c.3ă,

P"3""%,.,)+"/"+,%c,

· O(+"#c+c,-+c-c&'-.%.",§',

c#.,-c+c,-+c-c&'-.%.",/(+, ',"-c,"&)%"c+c,&c", &.%-(+,,)"c%"ş-",(',.%-c'ţ",

ş".,§',.'%,c3.+".,

.'ţ",,c.3c,+3",-'ţ",,

· K'-+/'ţ"",.cţ"('c%,

)'-+.,,ănă-c-,*c,-c,=<+,

,.)+c/ !+,§',('"ţ"",,

,-cţ"('c+0,

@0,Q1-+'c+c,.,++"+c,%c,

Rc"'ţ"",!")+-',"/",',"-ă, -+c-c&'-,ş",,.)+c/ !+, ('-"'.ă.,)(,"d"%ă,(c+,§',

c3.%,+,)-ă+"",

Q1-+c,.%,(d%" c-(+".,/c, ('ţ"'<,,

· P"c '(,-".%,)+"3c-, ,ăş.+c-=,

· T3.%-c-%,"'/,-" cţ""%(+, -.c-=,

· T(&c'ă+",1)%""-,

'"/%.%,)+"&c+,)'-+., -+c-c&'-,('-"' , ,.)+c/ !+,,

(',.-"/"-ăţ"",-c)%(+,,

c(+c+,c,c,",-'ţ",&"c%0,

)'-+.,)c"'-=,

· T(&c'ă+",)'-+.,

&".%,,c&"%"0,

,

=@

O0,=0,MNSQTK`OK,PQ,OQPPaK`Ă,

C. 1.1. Algoritmul general de conduită a pacientului cu HTA

1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,
1.1. Algoritmul general de conduit ă a pacientului cu HTA , ,

,

, KO_K,Jc%-!,Oc+,S."%"'<,J2)+-',"(',P"c
,
KO_K,Jc%-!,Oc+,S."%"'<,J2)+-',"(',P"c '(,",,c',`+c-&'-0,==,0,]>>_,*.,&(""ă+"+,
,
,
,
=A

C.1.2. Algoritmul de intervenţii ðn funcţie de TA iniţială ]>:_

, , , , =8
,
,
,
,
=8

C.1.3. Algoritmul terapiei medicamentoase ðn HTA,]>:_,

Rc,.%,K

Rc,.%,KK

Rc,.%,KKK

Rc,.%,Kb J")+-',".',

+3",-'-ă

Oc",-"'+", Oc",§',/›+,-ă, ,AA,c'" ,AA,c'" M,*,c.,N,+ O,,c.,P
Oc",-"'+",
Oc",§',/›+,-ă,
,AA,c'"
,AA,c'"
M,*,c.,N,+
O,,c.,P
M,*,c.,N,+,-,O,,c.,P
M,*,c.,N,+,-,O,-,P
Mă. cţ",,c.,α/d%(c'-.,,c.,
,)"+('(%c-('.,,c.,c%-,".+-",

M<,"'!"d"-(+,QOM O<,c'-c ('",-,c%,c'c%%(+,,c%".

N<,β/d%(c'-

P<,".+-","', +.)c,-"c3"%(+

,`+c)"c,(&d"'c-ă,.,,N,ş",P,&c",+/'-,)(c-,"'.,"cd-.%,3c!c+c-,

,,§',(&)c+cţ",.,c%-,(&d"'cţ""

,

,

=9

,

O0>0,PQ_OTKQTQM,OQ`QPQNQT.,`QJPKOKNQT,ŞK,RTQOQPaTKNQT,,

,

O0>0=0,O%c,""c+c,!")+-',".'"",c+-+"c%,

,,

`cd%.%,=. Clasificarea nivelurilor tensiunii arteriale (mmHg)

Oc- (+"c,,

`M,,

`M,

Q)-"&ă,,

>=><,

ş",

>:<,

P(+&c%ă,,

=></=>;,

ş";,c.,

:</:@,

Normal ðnaltă

=?</=?;,

ş";,c.,

:A/:;,

J")+-',".', +c,=,,

=@</=A;,

ş";,c.,

;</;;,

J")+-',".', +c,>,,

=8</=9;,

ş";,c.,

=<</=<;,

J")+-',".', +c,?,,

,=:<,

ş";,c.,

,==<,

J")+-',".',,",-(%"ă,"3(%c-ă,,

,=@<,

ş",

>;<,

R+"3ă+"<,,

O§',-',".'c,,",-(%"ă ş","c,-(%"ă,c,.'.",)c"'-,,,§'c+c3ă,§',c- (+"","+"-.,,,/c, c)%"c,c- (+"c,&c",§'c%-ă,)'-+.,.c'-""c+c,+",.%.",c+"(/c,.%c+,-(-c%.,"3"c,,-+c-c&'-,

ş",,-"&c+c,""'ţ",-+c-c&'-.%."0,

,

O0>0>0,O('."-c,)c"'-.%.",.,J`M,

Procedurile de diagnostic cuprind:

· ,.+ă+",+)-c-,c%,-',".'"",c+-+"c%,,

· /"'ţ"+c,c'-'-%(+,)+,('c%,ş",+((%c-+c%,

· 1c&'.%,%"'",,

· "'/,-" cţ""%,,%cd(+c-(+,ş",)c+c%"'"0,,

Oc,-c,=0,Paşii obligatorii ðn conduita pacientului hipertensiv,

=0 P-+&"'c+c, +c.%.",J`M, >0 K'/,-" c+c,(d%" c-(+",)+"/"',c-(+"",,+",.,c,"cd-.%.",3c!c+c-.,c,,"'+(&.%.", &-cd(%".,c-ă+"",(+ c'%(+,ţ"'-ă,§',J`M,ş",c,('"ţ""%(+,%"'",c,("c-, ?0 Oc%.%c+c,+",.%.",c+"(/c,.%c+,-(-c%,*-cd%.%,_OQTQ,c%,_("-ăţ"",Q.+()',, Oc+"(%( ",><<?+,O,/ţ",c'1c,'+0=0, @0 P-+&"'c+c,+",.%.",c"ţ"('c%,"'"/".c%,)'-+.,)c"'-.%,.,J`M,*-cd%.%,>.," .+c,=+, A0 M%ă-."+c,)%c'.%.",,"'-+/'ţ",)'-+.,)+,(c'c,('+-ă.,),-+&',,.+-,*=/?,%.'"+,ş", ),-+&',%.' ,ş",c)c"-ăţ"",,&.'ă0,,

,

=:

C.2.2.1. Calcularea riscului adiţional pentru pacienţii cu hipertensiune arterială

,

`cd%.%,>0,Factori care condiţionează riscul,,

=0,Rc-(+",,+",,

>0,_&',,c-c+,,.d%"'"ă,c,(+ c'%(+, ţ"'-ă,*MQŢ+,

· P"/%.%,`M,,",-(%",ş","c,-(%",,

· Jb_,%-+(c+"( +c",*_($(%(0/N2(', @?:,&&=,O(+'%%,@>@@<,&&,,&,+,,c.,

· P"/%.%,-',".'"",).%,c-"%,*%c,/§+,-'""+,,

· b§+,-c,*N,,AA,c'"=,R,8A,c'"+,,

· Jb_,(c+"( +c",*KOOb_,N,==A, ;& > .,R,;A, ;& > +,,

· R.&c-.%,,

 

· P",%")"&"c<,,

· P(/3",.%-+c,('( +c",,§' +(şc+,c, )+-%.",c+(-""c',*KO`,@<.;,&&+,,c., )%că,c-+(,%+(-"ă,,

 

ü O(%,-+(%,-(-c%,@@.;,&&(%;%,*=;<,

 

&

;%+,,c.,

 

ü NPN/(%,-+(%,@?,&&(%;%,*==A,& ;%+, ,c.,,

· b%("-c-c,c+(-"(/&.+c%ă,c,.'", ).%,.%.",@=<,&;,,,

ü JPN/(%,-+(%<,N,>=&&(%;%,*@<,

· K'"%,-',"('c%, %3'ă;d+cţ,><.;,,

 

&

;%+.,R,>=.>,&&(%;%,*@8,& ;%+,,c.<,,

· O+ş-+c,.ş(c+ă,c,+c-"'"'",,+"ă<,N<, ==A/=??,μ&(%;%,*=.?/=.A,& ;%+=,R<,=<9/=>@, μ&(%;%,*=.>/=.@,& ;%,

 

ü `+" %"+",@=.9,&&(%;%,*=A<,& ;%+,,

· S%"&"c,™,#.',A.8/8.;,&&(%;%,*=<>/=>A,

 

&

;%+,,

· Tc-c,,-"&c-ă,c,"%-+ă+"", %(&+.%c+,,ă3.-ă,

· `,-.%,,-(%+c'ţă,%c, %.(3ă,c%-+c-,,

*>8<,&%;&"';=.9?,&>+,,c.,%c+c'/.%,

· Qd3"-c-c,,-"),cd(&"'c%,*"+.&+"'ţc,

+c-"'"'",,ă3.-,*>8<,&%;&"'+,,

 

cd(&"'c%ă,@=<>,&,*N+.,@::,&,*R++,,

· O"+(c%d.&"'.+"c,?</?<<,& ;>@,!,,c., +c)(+-.%,c%d.&"'ă;+c-"'"'ă<,>>,*N+=,,c., ?=,*R+,& ; ,+c-"'"'ă,*>.A,*N+=,,c.,?.A, *R+,& ;&&(%,+c-"'"'ă+,

· K,-(+",c&"%"c%,,cţ".',c+"(/c,.%c+ă,

 

)+&c-.+ă,*N,>AA,c'"=,R,>8A,c'"+,

?0,P"cd-,3c!c+c-,

@0,Mţ".',c+"(/c,.%c+ă,,c.,+'c%ă,

(',-"-."-ă,O,('"ţ"",%"'",c,("c-,,

·

S%"&"c,™,#.',9,&&(%;%,*=>8,& ;%+,%c, ,.+ă-(+",+)-c-,,c.,

· Mţ".',+d+(/c,.%c+ă<,MbO,",!&"., !&(+c ",+d+c%ă.,c"'-,",!&",

· S%"&"c,)(,-)+c'"c%ă,@==,&&(%;%,*=;:,

-+c'3"-(+".,

 

&

;%+,

· Mţ".',c+"că<,"'c+-,&"(c+"., c' "'ă,)-(+c%ă.,+/c,.%c+"3c+, (+('c+"c'ă.,"',.""'ţă,c+"că,,

 

· Mţ".',+'c%ă<,'+()c-","cd-"ă=, ",.'ţ",+'c%ă,*+c-"'"'c,,+"ă,N,@=??., R,@=>@,μ&(%;%+=,)+(-"'.+",*@?<<,& ;>@,!+,,

· M+-+"()c-",)+"+"ă,

· T-"'()c-",c/c',c-ă<,!&(+c "",,c.,

1,.c-.,&,)c)"%c+,

P(-ă:,)+3'ţc,c,-+","',"'",c-(+",,+",.,)+"'-+,c+,(d3"-c-c,,-"),cd(&"'c%., %"&"c,™, #.',c%-+c-ă.,`M,@=?<;:A,&&J .,JPN/(%,-+(%,,ă3.-,ş",!")+-+" %"+"&",*('(+&,

"'"ţ"",,&c",,.,+,"'"ă,)+3'ţc,,"'+(&.%.",&-cd(%"0,

HVS: !")+-+("c,/'-+".%.%.",,-§' =, IMT<,*"'-"&c/&"c,-!"$',,+,?, +(,"&c,(&)%1.%.","'-"&c/&"c=,, IMMVS *"'1.%,&c,",&"(c+.%.",/'-+".%.%.",,-§' +,+,.-.,.,.',+c)(+-, +(,"&c,

+c3ă;)+-,@<.@A=,,

 

MbO,O,c"'-,/c,.%c+,+d+c%0,

=;

 

`cd%.%, ?0, Stratificarea hipertensiune arterială,,

riscului

ðn

cuantificarea

prognosticului

pacientului

cu

   

Tensiunea arterială (mmHg)

 

Alţi factori de risc, leziuni organice subclinice sau afecţiuni

P(+&c%ă,

P(+&c%ă,

J`M,,

J`M,,

J`M,

`M,,=></=>;,

§'c%-ă,

+c,K,

+c,KK,

+c,KKK,

,c.,

`M,,=?</=?;,

`M,,=@</=A;,

`M,,=8</=9;,

`M,=:<,

`M,:</:@,

,c.,

,c.,

,c.,

,c.,

`M,:A/:;,

`M,;</;;,

`M,=<</=<;,

`M==<,

         

T",,

 

P"",

.',

c%-,

T",, &".,

T",,&".,

T",, c"ţ"('c%,

T",,c"ţ"('c%,

c-(+,,+",,

)().%cţ"('c%,

)().%cţ"('c%,

&",

&(+c-,

c"ţ"('c%,

§'c%-,

         

T",,

 

=/>, c-(+", , +",,

T",,c"ţ"('c%,

T",,

T",, c"ţ"('c%,

T",,c"ţ"('c%,

c"ţ"('c%,

&",

c"ţ"('c%,&",

&(+c-,

&(+c-,

(c+-,

 

§'c%-,

 

?,c-(+",,

           

+",<,

 

,"'+(&,

 

T",,

&-cd(%".,

%3".'",

(+ c'",

T",,c"ţ"('c%,

&(+c-,

T",,

c"ţ"('c%,

§'c%-,

T",,c"ţ"('c%,

§'c%-,

T",, c"ţ"('c%,

§'c%-,

c"ţ"('c%,

(c+-,

§'c%-,

,.d%"'",

,"cd-,

 
 

N(c%ă,

c+"(/c,.%c+

ă,

,c.,

+'c%ă,

T",,c"ţ"('c%,

(c+-,§'c%-,

T",,

c"ţ"('c%,

(c+-,§'c%-,

T",,c"ţ"('c%,

(c+-,§'c%-,

T",,c"ţ"('c%,

(c+-,§'c%-,

T",,

c"ţ"('c%,

(c+-,

(',-"-."-ă,

 

§'c%-,

P(-ă<,Riscul cardiovascular este stratificat ðn patru categorii. Riscul mic, moderat, ðnalt şi foarte ðnalt se referă la riscul de evenimente cardiovasculare fatale şi non-fatale la 10 ani. Termenul „adiţional“ indică faptul că pentru toate categoriile riscul este mai mare decðt media,

,

`cd%.%,@0,Criterii de risc ðnalt/ foarte ðnalt

·

`M,,=:<,&&J ,ş";,c.,`M,==<,&&J ,,

·

`M,,@=8<,&&J ,.,`M,,ă3.-ă,*>9<,&&J +,,

·

P"cd-,3c!c+c-,,

·

_"'+(&,&-cd(%",,

·

?,c-(+",,+",,c+"(/c,.%c+,,

·