medicina44巻1号

2007年01月発行

今月の主題 高血圧の臨床―焦点の合った個別診療へ向けて 合併症を有する高血圧患者の特徴と有効な降圧療法

虚血性心疾患

著者： 平田浩三¹ 百村伸一¹

所属機関： ¹自治医科大学大宮医療センター循環器科

ページ範囲：P.124 - P.128

ポイント

●日本の冠動脈疾患患者数は，約90万人と推定されており，脳血管障害や喘息の患者数に匹敵する．

●高血圧は冠動脈疾患の重要なリスクファクターであり，これは冠動脈疾患患者にとっても同様である．

●冠循環の特殊性と降圧薬の特徴をふまえ，個々の患者に適した降圧が望まれる．

参考文献

1)厚生労働省：平成14年 患者調査の概況．

2)Hansson L, et al：for the HOT Study Group：Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension：principal results of the Hypertension Optimal Treatment(HOT)randomized trial. Lancet 351：1755-1762, 1998

3)Prospective Studies Collaboration：Age-specific relevance of usual blood pressure to vascular mortality：a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360：1903-1913, 2002

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5)The Heart Outcomes Prevention Evaluation(HOPE)Study Investigators：Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 342(3)：145-153, 2000

6)日本高血圧学会高血圧治療ガイドライン作成委員会(編)：高血圧治療ガイドライン2004，ライフサイエンス出版，2004

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9)The PEACE Trial Investigators：Angiotensin-Converting-Enzyme Inhibition in Stable Coronary Artery Disease N Engl J Med 351：2058-2068, 2004.

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11)COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial)collaborative group：Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction：randomized placebocontrolled trial. Lancet 366：1622-1632, 2005

12)Yamada K, et al：Effect of beta-blockers on the mortality of Japanese patients with myocardial infarction. Int J Cardiol 108(3)：309-313, 2006

13)ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group：Major outcomes in high risk hypertensive patients randomized to Angiotensin-converting enzyme inhibitor or Calcium Channel blockers vs diuretic. The hypertensive and lipid lowering treatment to prevent heart attack trial(ALLHAT). JAMA 288：2981-2997, 2002

14)Hirata K, et al：Benefits from angiotensin-converting enzyme inhibitor ●beyond blood pressure lowering’：beyond blood pressure or beyond the brachial artery? J Hypertens 23：551-556, 2005, Erratum J Hypertens 23：905-906, 2005

15)Poulter NR, et al for the ASCOT investigators：Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm(ASCOT-BPLA). Lancet 366：907-913, 2005

16)The CAFE Investigators for the Anglo-Scandinavian Cardiac Outcomes Trial(ASCOT)Investigators：Differential Impact of Blood Pressure-Lowering Drugs on Central Aortic Pressure and Clinical Outcomes Principal Results of the Conduit Artery Function Evaluation(CAFE)Study. Circulation 113：1213-1225, 2006