軽症高血圧患者の長期薬物療法における生活の質（QOL）の評価に関する検討

Assessment of quality of life (QOL) in long-term pharmaceutical therapy of the patients with mild hypertension

　今日，多くの慢性成人病の治療においては治癒を期待することが困難であり，ケアの究極の目標は疾病の進行を阻止し，症状を改善し，再発を予防することにある。特に，慢性循環器疾患では，診断技術や治療法の格段の進歩によって再発率や死亡率は低下の傾向を示しており，このことは，治癒を期待しえない患者が社会生活をする際に，QOLをいかに高く保つかがケア上重要な要因となることを意味している^1）。そのような観点から，軽症高血圧，急性心筋梗塞後のリハビリテーション，A-Cバイパス術後，拡張型心筋症のケアにおいては，治療によるQOLの変化を定量的に捉えることが必要とされ^2），これまでにも種々の試みが報告されている^3,4）。今回は，ライフプランニングセンター（LPC）で継続的に管理されている軽症高血圧の男性患者について，アンケート調査によるQOL評価の試みを行ったので報告する。

Recently, much attention has been paid to QOL in clinical trials of cardiovascular therapies, especial-ly to the patients with mild hypertension, dilated cardiomyopathy, A-C bypass surgery and acute myocardial infarction. Thirty seven male patients with mild essential hypertention who have been treated for several years at the Life Planning Center by stepped care system and have been in stable condition were selected for the study. Questionnaires related to 7 major QOL categories represented by 9 quantitative scales and 5 qualitative measures were completed by all subjects and were carefully re-viewed by nurses with additional interviewing, if necessary.

All subjects were divided into 4 groups based on the drugs prescribed ; 13-blockades (β G), Ca-anta-gonists (CaG), combinations of both (β CaG) and others (combinations of diuretics and a-methyl DOPA). Antihypertensive effects were satisfactorily obtained in all groups and no measurable pharma-cological side effects were uncovered in either sub-jective or objective measures.

QOL assessed with 9 quantitative scales consisting of blood pressure stability, well being feeling, sleep disability, vitality,concentration and memory, anxei-ty, family communication, participation to community events and life satisfaction was compared among 4 groups. Blood pressure stability judged by patient themselves was the highest in OG and the lowest in 13G, probably related to the initial blood pres-sure level. Sleep disability was the highest in OG and the lowest in CaG. Vitality was the highest in OG and the lowest in βG. The scale related to concentration and memory was the highest in OG and the lowest in β CaG. No other scales revealed significant differences among the groups studied. Nine QOL scales were evaluated on the relation to age and only one scale, family communication, re-vealed significant positive correlation to age. There-fore, it comes to conclusion that significant differ-ences observed in quantitatively measurable QOL scales among four groups were not influenced by age.

In summary, apparently well controlled hyperten-sive subjects with four different pharmaceutical measures were compared with QOL scales. Signifi-cant differences independent from age were deter-mined in 4 of 9 scales evaluated. The importance of assessment of QOL in the long-term continuous treatment of mild hypertension was discussed.