Ca拮抗薬nilvadipineによるmonotherapyを中心にした高年者高血圧の長期治療に関する研究

Studies on Long-term Treatment of Eldery Hypertension with Special Reference to Monotherapy Using Ca Channel Antagonist, Nilvadipine

　【目的】高年者高血圧の薬物療法の有用性をCa拮抗薬nilvadipine（NP）の3年間の長期使用について検討した．【対象】20の医療施設に1989年4月より1年間に受診した60歳以上の高血圧患者127例を対象とし，NP 2〜4 mgを1日2回用いた．治療開始前，1年後，3年後について血圧値，一般検査値，心血管事故の発生を評価した．【結果】21例は副作用，転居，転医，その他不明の理由で脱落した．対象者全体（104例）として血圧は3カ月以内に有意に下降し，以後3年間同様の血圧レベルを維持し得た．年齢，性別によって降圧効果に差はみられなかったが，高い血圧レベルほど大きい降圧が得られた．心血管事故の発生に関しては年齢や登録時の血圧高とは関連を示さなかったが，女性より男性で，またWHO病期分類が重度なほど高リスクであった．【結語】nilvadipineによる長期monotherapyは高年者高血圧の治療において至適な降圧をもたらすと考えられる．

OBJECTIVES: Efficacy of long-term antihyperten-sive treatment on elderly hypertensive patients with nilvadipine was assessed with regard to blood pressure lowering and cardiovascular events. METHODS: One hundred and twenty seven elderly hypertensives visitedto 20 multiple hospitals, clinics and dispensaries in Ichihara and Yohkaichiba areas, Chiba prefecture from April 1989 to March 1990. Nilvadipine (2mg) was prescribed one to two tablets twice a day for 3 years. Evaluation was performed on blood pressure. routine laboratory data and cardiovascular events. RESULTS: Twenty one cases dropped-out because of drug adverse effects, movements, poor patient compliance and other unidentified reasons. As a whole in 104 cases, depres-sant effect was obtained within initial 3 months and it was maintained thereafter for 3 years. Age and gender did not affect the therapeutic efficacy, but higher the initial blood pressure level, the greater the depressanteffect. There were no cardiovascular deaths observed. Nonfatal cardiovascular events, however, were not significantly related to age and the initial blood pres-sure levels, but gender and severity grade after WHO criteria. CONCLUSIONS : Long-term treatment with nilvadipine on elderly hypertensives was effective to maintain the blood pressure level within the adequate therapeutic range for 3 years. Male and increased severity grade after WHO criteria were identified as significant risk predictors with regard to nonfatal car-diovascular events.