バレニクリンを用いた禁煙治療：血圧と体重変化の検討

Smoking Cessation Using Varenicline:Analysis of Factors Correlated with Maintaining Abstinence Rate

要旨　禁煙治療は呼吸器機能の改善が期待される一方，その後の体重増加による循環器機能や代謝機能への悪影響が懸念される．本研究では禁煙治療の血圧と体重への影響を検討した．2008年10月より2013年6月までに当院でバレニクリンによる禁煙治療を行った高血圧症例(72例)と非高血圧症例(238例)の310例について禁煙治療前後の体重と収縮期血圧(SBP)および拡張期血圧(DBP)の変化を調べた．全体の禁煙成功例と非成功例の体重の変化は1.34±1.64kgと0.8±1.68kg，Body Mass Index(BMI)の変化は0.49±0.59kg/m²と0.29±0.62kg/m²で，禁煙成功例で有意に体重とBMIが増加した(p＝0.04，0.045)．高血圧症例の禁煙成功例(49例)と非成功例(23例)の体重の変化は1.6±1.8kgと0.7±1.2kg，BMIの変化は0.59±0.67kg/m²と0.24±0.42kg/m²であった．SBPの変化は－9.9±12.7mmHgと1.3±17.3mmHgで，DBPの変化は－6.2±8.7mmHgと4.9±16.5mmHgで，いずれも禁煙成功例で有意に血圧が低下した(p＝0.005, 0.01)．非高血圧症例の禁煙成功例(171例)と非成功例(67例)の体重の変化は1.29±1.58kgと0.81±1.87kg，BMIの変化は0.46±0.57kg/m²と0.3±0.69kg/m²であった．SBPの変化は－1.3±12.8mmHgと－0.1±13.5mmHgで，DBPの変化は－0.6±9.9mmHgと－0.9±10.1mmHgで，いずれも有意差を認めなかった(p＝0.58, 0.86)．高血圧症例では禁煙成功例は体重増加にもかかわらず非成功例に対して有意に血圧が低下した．

　It is widely known that smoking cessation contributes to the improvement of respiratory function;however, metabolism and circulatory function are adversely affected by weight gain after smoking cessation, which may be a concern. In this study, we analyzed the influence of smoking cessation on blood pressure and weight gain. We assessed the effect of smoking cessation on blood pressure and weight gain in 310 participants who received varenicline to induce smoking cessation from August 2008 to June 2013. Participants’ weight, body mass index(BMI), systolic blood pressure(SBP), and diastolic blood pressure(DBP)were measured before and after smoking cessation, and they were divided into two groups:hypertension(n＝72)and non-hypertension group(n＝238). The average abstinence rate was 71%(220/310)overall, 68.1%(49/72)in the hypertension group, and 71.8%(171/238)in the non-hypertension group. The abstinence rate between the hypertension and the non-hypertension groups was not statistically significant. Compared to the participants who did not succeed in smoking abstinence, those who did, showed a significantly greater increase in weight(p＝0.04)and BMI(p＝0.045). Further, in the hypertension group, the successful abstainers showed a statistically greater decrease in SBP(p＝0.005)and DBP than those who did not succeed(p＝0.01), whereas all the participants in the non-hypertension groups showed no statistical changes in SBP(p＝0.58)and DBP(p＝0.86). Therefore, successful abstainers in the hypertension group showed a greater decrease in blood pressure despite weight gain.