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1 REGIONE LAZIO Via A. Fabi s.n.c FROSINONE Tel # $ # % & ' ( & ) * +$ ' '*( # -. ' & / ' * ) ( Struttura Semplice di Staff di Direzione Generale Protocolli Assistenziali e Linee Guida Via A.Fabi s.n.c Frosinone Tel

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7 $ 4 GG <<= * '> = GKG > $ =A $> =>J = $> $ =$$A $ $> D : 5G149JJ D 11 1G 455L JJJ 4 =4> D 11 1G 455JJJJ =A 0>I 9 1G 115 : 5G149 $ =$A $ >I D : ;G G455? 9 1G115 4 : ;G135?J '#) JJ) ; JJJ )* ' JJJJ'$$B:6 ) '

8 $ - '? 45K35 ' 8 $ 8 A<A A & A L L A * A& +A +1A#M +/A / AD A A A 2 % / G / 6 6 B 7 8 ' ) * 9 ) : ; ) +<$/ ;= ( *

9 > * + )? D N O =DN> # * ' + ( ) + *4G B * =( ' * G ' + ( ) ) ' 4 + '01 =59+5:7 > )- + ( 2* 0 & $ + ( - +81:(

10 ) D ' ' 0? ' /1/9= + ( + (- + $ + ( = O D&1> ' + => = N > +1 = + + E +1> = > 2 ' +/ # + ' 4 +1

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12 ' ( 5 ' '. )< 43 '.?0 ' ' 1 4 ' +? ' + * 1 * ( ' => ( * ' ' * ( ( + ( * ( '* $ B 14 => ' # 1 * (

13 ) * 3 $ # + 1 C6; ( + O => 01 ' * D + ( * ' - * 2* * '+$5 222% 5( 3 $ ( ( ' 0O O * ( * ( ( D ' ) * + % (+QR=%R>E1 * ' ) ' ' $ D # )) 3 *'# ) ) 67 4 * ( * 4 * -.

14 ' ( ) ( ( ' = >? 0 #M $ O 4558? 3 $ 3 ' +S( A ( ' =F45DG> G '( - )? B + * * ( $ & =N> =00( + / /

15 A #A # A # = > # &T * A $ D 0 * ( ( ) $ ' 4 '+?/8CAFC<() ( 4 + * ) $OO 9 ' ( ' ' ' F185 0 F;50

16 D # <+0$ 14; 0 * <+?$ *F185G;50 * ) - ' ) + ' +?#+<0+ < 3 2B 14<GG( ( ' G + #+ + #+ #+ '+$54( + H5A ( $ + #+G&< ' + + ' 0$ +$G 1I ) < $J ( 1. M U K #+ &?/#$ + & G( ' + ( 0 ) $+<+$ 13D 14 ) I $( ( ' ' ( 5 '

17 #+&< + ' *' H135 0 H25 0 ' ( + * ( ) :20 / - #+ &< ).B ' A ' ( ( ( ) * ' E 0 + ' & <G1 - * ( '1 '< ' 4559 * F H185

18 ? $ 6 1 $ 6 $ 3 3 $ $ L J H2 2$A23 6CC; M/;9A M/;9A M/CCA M;CA 3 <?8C A?9C A M/9CA M/CCA?8CA M/9CA MF;A M;CA?8C A?8: A M/9CA + ' - ' ( ' 0 * * * V ' + +1 / C ' '

19 #$ ) $ ' ' O Q => * ' '55NC:F+ 3F9= C971CFC( C F9= C/81C;6( ( * +N/C7/( # 55NCOF+ 3F9= C:61/6:( 55N/67+ 3F9= C:F16/F( (? ' * + <( ( 35 + # (+ & <( ) + &( $ - $ + <( #$ %- + (+ <( ' ' ( 851+ / (? ( ' L L S

20 + * ( ' & ( ' * - / 0 ' ' C % O ( #' * K $ ' % *# 1G8 ' 427 '# :27 * - '# ( ';;7 ( :37 ' )

21 $ ' ' A # /(H86'( 4-= ( ( > ' ' ( A # # 'C + 719(+ / &<( + /17 ( # # = C F52 > $ =# G >+ / <( + (? + + (? ( 66 #+ + (

22 ? ' + <( / ) ( -* - ( M+ > $ + <$/3( 3 ) 4+3 * 2* :16O= $=$> $ ) ' * H) 4686 ( 36 :3 D ';;7 # ';7 * 137 ( # ) 2* + ' ) 9

23 $ 9 ' $#&#&#&#<&/&# $G# #<WWW?#& $#&W?&#0# ( ( (( // ( $=$> X?= > / (& ) # #+ / $=$> & =&> 3 # <+# *1 +$+ 3 # - (& $ ' - *

24 # ' $ ' 1 - ' $ # * ) ;C1FF= * '# F 857 / ) ' -* - 2 * = > > - ' 17 ' ' * *) & -* & - * ' (

25 * ' - ( 1 4 ( 8 ' / # & ( 14 &?? &? ( 95( B 45 ' # 4 ) '17 1* 4 ' - '

26 ' ' - - 2* + ( 1 * 4 ' ' ' ' ' ' A + 5%$( ( =$ :;> $ : =&> & RD non proliferante ( grave o pre-proliferante) RD proliferante # # Oftalmopatia diabetica avanzata

27 $ ; G #? => #? &= +> ( Y? #+ + & Z?? = >? =.> # (A + ( ( 0 ' *( & % + - +( %

28 ' # + ( + G ' ' ( B & +?/A7 * ( )* 655[ 655 [ 1 * (). B ' ) A 1 4 ) * * ) - 8 )* ' 3 6 = > * '() 9 +

29 B - A =G> # +O. ' A B ( ' Z ' ) *A + ( + 8C= /6 ( V * V ( ) S+ - * $ 2 ( $ 15

30 ) E ' # $ 2 &A

31 14+43? # G G Z * Z (= >G G G =&> 9 8 Z( G G =H1G8 ' > + + Z $ 15+( 1 G 6 (

32 4 - ' 4 V)( ' 8 * ( ' # -* * % * A '( ( ' '= > GG * ) ' => ) ' A '

33 # + ' * G B A =$> =&$0&$> => $ + ( ) / 1. ( - ' ' ( - 4 G * DD 8 ) - 0 8) =&> & & ( ( H 14 ' * + '

34 ) D & = > *? ' =#&> D ; :5+; D 1:7 # 4 ' $ ;: * & $ 122:=;7 > ) :+18 * : G> ( * ' ' > ' ' ' ' ) ' * ' ' + $A3 $25( G G 1 G E GO $

35 1 4 ' *? 11 * $ 11 &=<> ' Approccio non farmacologico Se dopo 4-6 sett.pa ancora 130/80 ACE-I o AIIRA = >\+ = > Aggiungere un 2 farmaco di altra classe o sostituire (ideale: ACE-I + Ca-Antag.) Se dopo 3 sett. PA ancora 130/80 Se dopo 3 sett.pa ancora 130/80 Sostituire o aggiungere un 3 farmaco (spesso un DIURETICO specie in pazienti edematosi) Aggiungere un 4 farmaco (ideale: AIIRA + ACE-I) Se dopo 3 sett. PA ancora 130/80 Se dopo 3 sett. PA ancora 130/80 Sostituire un farmaco con un altro Polso 80 Polso < 80 Inserire -blocc. C. Selett. O --bloccante Inserire 1-Blocc. Se il primo farmaco risulta del tutto inefficace nell arco di 3 settimane o in presenza di effetti indesiderati è necessario sostituire il farmaco in atto con un altro tra quelli precedentemente menzionati. In caso non vengano raggiunti valori pressori inferiori a 130/80 nell arco dello stesso periodo orientativamente si dovrà associare al primo un secondo farmaco tra quelli sopra riportati. ' ' '

36 ' ' :67 185G;50 * ' + +& ( ' ' ' 14 01F:67 A145G:5+:6F G;5IH65 # 1Y 4& + A #+1& A + G+ 185G;50 ' =52+15GNG> $ =<> A145G:6(F G;5(H65 # 1 4& + A #+1& A + + =6+9G> =5:+52GNG>

37 H:5 G '? ) % - $?A $ # # - ( 2* * ) # )-* ' ) * > ' ( * - ' E ) ( ' ; #?

38 ) *? ) A # A # A 1 #22% * A 2% & * ';67 ' ) 59+5;7 U ( * ( ( - + (=$ 14( $ 14 (

39 /# $#?W $$/$'&?$$##?$& ( ( ( A #%D##&?$# D + 83; ' *? ' ' ' ( * ' ' * ) ' ' ' & ' # '

40 14 9 ( 837 ( ' (=9;7 6>8 ( # ( - D' ) ';67 * ( ( ' ' - ' B ' - K ' $ - =$ 18 $ 13> + / <( $ 18 '

41 ( $ $ ( ( ) $ 13 $ $ ' 9 A KY Y K ' * 8+9 A KY + Y ) + ( K ' $ =$ 16> + ( $ 16 /P 6P 7P ' / ' ( *

42 ' * + 1Q /C ( + /6O1< ( + ( * * A +$4 ( + <( + ( * * / +( 6 + ( 7 + ( + / <( K / 6 + / <( 2 68 / + ( 6 ' * 7 + ( 8 9 *0 : + 5%( ; + / <( + <( * +)D6?7C <( * + <(

43 3 # * + / <( * / 6' 7' * + / <( * * + ( 1 =/> + <( + <( + ( + / <( ' ) IH149G ; IH455G * IH455G 4 :6 = > G $ = $ ( 4 '$$ G $

44 # ) * + 4%?69@A() B * #$ 4 '01+C:1C;= ( - +81:( ' ' /1/9= ' M $ #$ +. 1 '? 4 * ' ' ( ' - '. )< 43 '.

45 ( * ( ( 14 ( ( D ' ) * + A # # 'C + 719(+ / &<( + /17 ( # # = C F52 > $ =# G >+ / <( / (& ) # #+ / $=$> &=&> $3 - '#<+# *1

46 +$+ 3 # ( * ' - ( 1 / 4 ( 8 ' / # & ( 14 * 1 % GG] 4 *)] 8 * ] 3 * ] 6 * ] 9 *] : ] (] ; ] ] ) A : ; ) A 1

47 ? ; & B - A G 0 'A + ( + 8C= /6 ( ) E ' # ( 1 G 6 ( ' 4 V)( ' 8 * ( ' # -* *

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49 ? #' A # A # A 1 #22% * A 2% ' ' - ' B ' - + ( * * / +( 6 + ( 7 + ( + / <( K 0 + / <( $ '

50 ) B ( G ' & /? = > ' / /A $ A / & * ))$ / 2 <$/ & / % 3+ ( > ) 2 H $ & & ) +( 1

51 3 3 $ A 1 3 = > U ' ' # ' 1> A / # 3 * 4>* 8>/ 4 3> A * 6> A 5 9> :>$ ;> '( ' & $. &. A 1># A

52 ( + H( 4> 8># ' 3> 6> 14 9> :> S+ ;> '* 2> = > 15>& 11> $ *A $ 1 R * # %H A+ ( 1 1 %H 4 I1 8 + ( + % H ( 1 3 /9+ 4( 4 * C+ 8( 6 9 <$/?O= DA

53 1 8O+ 1( 4 8 5* 3 6 3* A ) $ + / ( ). * * ) % H I $ 3) 1 # A 4 # Z S+ 8 3 # Z 6 9 : = > ; S+ 2 # A & S 14 / 3 3

54 3 18 = > 13 & 16. #) ( $ ) %H # A / & * ))$3 / 2 <$/ & 3 3 / % 3+ ( > ) 2 H $ & 5 A

55 1 2#M89C :87?:88TTTTTTTTTTTTT 4 4% +4G%B(M69JA6C 4% 6917CJA6 /?7CJA67TTTTTTTTTTTTT 3. 3' MF8MOCC F81/C6OC1OO7?/C6?OO8TTTTTTTTTTTTT 3 # 7C C UD6TTTTTTTTTTTTT 6 3 U C /TTTTTTTTTTTTT 9. < UD C 6TTTTTTTTTTTTT :. + ( + D C (U 9TTTTTTTTTTTTT ;. * D C U 7 9TTTTTTTTTTTTT &E + /1O(TTTTTTTTTTTTT /C& M;<A//CC ;1// A/69 /61/8A/: /916C A/7?6C A/6 $ '

56 ' +? ' ) E B 0 - ' * - * + <

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