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Kokyu to Junkan Volume 38, Issue 1 （January 1990）

呼吸と循環 38巻1号（1990年1月発行）

Japanese English

研究

1日血圧変動パターンからみた降圧療法の適応決定ならびに降圧目標値の設定 Evaluation of antihypertensive therapy by amubulatory blood pressure monitoring and establishment of the level of antihypertensive goal on the circadian rhythm of blood pressure 藤岡達雄 ¹ , 田巻俊一 ¹ , 不藤哲郎 ¹ , 中江出 ¹ , 菅原照 ² , 神原啓文 ³ Tatsuo Fujioka ¹ , Shun ichi Tamaki ¹ , Tetsuro Fudo ¹ , Izuru Nakae ¹ , Akira Sugawara ² , Hirohumi Kambara ³ ¹武田病院循環器内科 ²武田病院内科 ³京都大学医療技術短期大学部 ¹Department of Cardiology, Takeda Hospital ²Department of Internal Medicine, Takeda Hospital ³College of Medical Technology, Kyoto University キーワード： 24時間血圧（24-hour blood pressure） , 携帯型血圧連続測定装置（ambulatory bloodpressure monitoring） , 本態性高血圧（essential hypertension） Keyword: 24時間血圧（24-hour blood pressure） , 携帯型血圧連続測定装置（ambulatory bloodpressure monitoring） , 本態性高血圧（essential hypertension） pp.71-76

発行日 1990年1月15日 Published Date 1990/1/15

DOI https://doi.org/10.11477/mf.1404900085

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Abstract 文献概要
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　降圧剤投与の決定およびその治療効果を評価する場合は，随時血圧を基準として評価するより，1日の血圧変動パターンを考慮して各人の病態に応じた降圧剤投与を行うことが必要と考えられるようになってきている。我々は正常血圧者50例，未治療高血圧症患者50例，各種降圧剤投与前後測定し得た50例，合計150例を対象とし，1日血圧変動パターンからhyperbaricならびにhypobaric indexを計測し，24時間の血圧値についての評価法を検討し，降圧効果判定についても若干の考察を行った。その結果，今回検討した評価法は降圧剤効果判定に非常に有用かつ簡便な方法と考えられ，降圧療法の適応決定ならびに降圧目標値の設定が可能であった。今後，24時間血圧変動パターンよりみた高血圧症の診断基準の設定が可能になると考えられた。

We have developed a new method for the evalua-tion of antihypertensive therapy on the circadian rhythm of blood pressure and attempted to determine the indications for antihypertensive therapy and the level of antihypertensive goal.

Blood pressures were measured for 24 hours by the use of ambulatory blood pressure monitoring using 630 (ABPM-630) in 50 normotensives, 50 untreated hypertensives and 50 hypertensives undertreatment with various antihypertensive drugs (110 males and 40 females, with a mean age of 53. 4±13. 3 yrs). Blo-od pressure profiles were prepared for determina-tion of the hyperbaric and hypobaric indexes. Acco-rding to the WHO's definitions for blood pressure, the hyperbaric index was defined as the area above 140 mmHg in systolic blood pressure or 90 mmHg in diastolic blood pressure, and the hypobaric index, as the area below 100 mmHg or 60 mmHg, respectively.

The criteria of the hypobaric index was obtained from the mean basal blood pressure (the lowest blo-od pressure during sleep) of the 50 normotensives.

The mean hyperbaric index of the 50 normoten-sives was 20.4±40.2/5.5±15.3 (systole/diastole) mmHg･hour/day and the mean hypobaric index, 12.2 ±22.5/9. 0±24.0 mmHg･hour/day. The 50 untreated hypertensives showed a mean hyperbaric index of 281.8±197.0/156.0±126.1 mmHg･hour/day and a mean hypobaric index of 0.1±0.6/0.3±1.5 mmHg･hour/day.

Comparison of the indexes before and after treat-ment with various antihypertensives showed that a decrease in the hyperbaric index without an increase in the hypobaric index was the most optimal reduc-tion of blood pressure. The effect of antihyperten-sive therapy should not be evaluated on the basis of the hyperbaric index alone, but hypotension due to excessive antihypertensive treatment should also be taken into account. Therefore, we evaluated antihy-pertensive therapy on the basis of both hyperbaric and hypobaric indexes.

The present method is thought to be very useful and simple in the evaluation of the effect of antihy-pertensive therapy. It permitted establishment of the indications for antihypertensive therapy and the ideal level for blood pressure fall. Further studies using this method may lead to the establishment of the diagnostic criteria for hypertension on the basis of the pattern of 24-hour blood pressure monitoring.