経皮的腎動脈形成術施行後の難治性高血圧に対するテルミサルタン投与法の検討

Administration of Telmisartan for Residual Hypertension after Percutaneous Transluminal Renal Angioplasty：a case report

要旨　脳梗塞，陳旧性心筋梗塞，閉塞性動脈硬化症を呈す66歳男性が，難治性高血圧の精査加療目的にて入院した．右腎動脈に99％狭窄を認め，レニン高値を呈し，腎血管性高血圧と診断した．右腎動脈形成術にて，収縮期血圧は190-210mmHgより160-180mmHgまで低下，telmisartan20mgの追加にて140-170mmHgまで改善したが，クレアチニンが30％上昇し，それ以上の増量はできなかった．telmisartanは，朝投与では日中降圧は十分ながら反跳性に早朝高血圧が増悪した．夕投与では早朝高血圧は抑制されていた．腎動脈形成術後に残存する高血圧に対するtelmisartanの投与法について，文献的考察を交え報告した．

Summary

　A 66-year-old man with cerebral infarction, previous myocardial infarction and peripheral vascular disease was admitted to our hospital due to uncontrollable hypertension. He was diagnosed as a case of renovascular hypertension because of the 99% stenosis of his right renal artery and elevation of plasma rennin activity. Although systolic blood pressure was reduced 30mmHg after percutaneous transluminal renal angioplasty(PTRA), morning hypertension still remained. A morning administration of telmisartan(20mg) decreased the patient's blood pressure adequately during daytime, but worsened morning hypertension developed. However, an evening administration improved it. An increase in the dosage of telmisartan was not permitted because of a 30% increase in serum creatinine level. It was suggested that evening administration of telmisartan was effective in cases where the patient's condition allowed only small dose usage, such as in this case of residual hypertension after PTRA.