胸部および胸腹部大動脈瘤患者におけるolmesartan medoxomilの効果―降圧効果と大動脈瘤径拡大抑制（OLM 40 Study）

Effects of Olmesartan Medoxomil on Patients with Thoracic and Thoracoabdominal Aortic Aneurysm；Evaluation of Anti-hypertensive Effect and Possible Suppression of Aneurysmal Dilation （OLM 40 Study）

大動脈瘤の発症，さらに瘤径拡大は高血圧症との因果関係が知られている1）．したがって，大動脈瘤の診断後，手術施行にいたるまでの待機的期間中には，さらなる瘤径の拡大を抑え，破裂を回避するための血圧管理が重要となる．

We evaluated the blood pressure （BP） lowering effect and possible suppression of aortic enlargement by olmesartan （OLM） in patients with thoracic and thoracoabdominal aortic aneurysm. In this single center prospective, forced titration study, 50 patients were registered between 2008 and 2011. After all patients received any of OLM 10, 20, and 40 mg/day as an initial dose, the dosage of OLM was titrated up to 40 mg as needed during follow-up period. Home BP （HBPs）， aortic aneurysm size assessed by computed tomography （CT） scan, indices of renal function were recorded at 3- and 6-months follow-up. Depending on whether 40 mg/day of prescription was continued for more than 4 months or not, the patients were divided into 2 groups：less than 40 mg （＜40 mg） and 40 mg groups. Morning HBPs tended to decrease in both groups, and the percent changes in BPs were essentially the same regardless of dosage. The absolute value of aortic diameter tended to slightly enlarge only in ＜40 mg group. Also in the ＜40 mg group, the absolute differences in aortic diameter between those at the time of study registration and each follow-up were 0.5±1.8 mm at 3-month and 1.2±2.3 mm at 6-month （p＝0.047）， whereas the percent changes were 0.9±3.3％ and 2.2±4.5％ at 3 and 6 months, respectively （p＝0.058）. As for 40 mg group, the absolute differences and percent changes did not reach statistically significant increase during the follow-up period. No severe renal dysfunction related to OLM 40 mg prescription was observed. Our results imply that OLM 40 mg may suppress aortic aneurysmal dilation independently of blood pressure lowering effect. Further study with larger number of sample size is warranted to assure this observation.