medicina45巻4号

2008年04月発行

今月の主題 一般内科医が診る循環器疾患―3大病態を把握する 虚血のマネジメント

冠動脈疾患例では，血圧とコレステロールをどこまで下げるか

著者： 深尾宏祐¹ 大村寛敏¹ 代田浩之¹

所属機関： ¹順天堂大学医学部循環器内科

ページ範囲：P.652 - P.655

ポイント

●少なくとも140/90mmHg未満を目標に血圧管理をする．

●厳格な血圧管理が心血管イベント予防には重要である．

●LDL-C100mg/dl未満を目標に薬物療法を行う．

●LDL-C値にかかわらず，積極的LDL-C低下治療の有効性が報告されている．

参考文献

1)Nippon Data 80 Research Group：Impact of elevated blood pressure on mortality from all causes, cardiovascular disease, heart disease and stroke among Japanese；14 year follow-up of randomly selected population from Japnese-Nippon data 80. J Hum Hypertens 17：851-857, 2003

2)Obara F, et al：Influence of hypertension on the incidence of cardiovascular disease in two rural communities in Japan；The Tanno-Soubetsu Study. Hypertens Res 30：677-682, 2007

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

4)Staessen JA, Wang JG, Thijs L：Cardiovascular protection and blood pressure reduction；A metaanalysis. Lancet 358：1305-1315, 2001

5)Wang JG, et al：Prevention of stroke and myocardial infarction by amlodipine and angiotensin receptor blockers；A quantitative overview. Hypertension 50：181-188, 2007

6)CAMELOT Investigators：Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure；The CAMELOT study；A randomized controlled trial. JAMA 292：2217-2226, 2004

7)Cannon CP, et al：Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators；Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 350：1495-1504, 2004

Lower is better and physiologically normal. J Am Coll Cardiol 43：2142-2146, 2004

9)Cannon CP, et al：Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 48：438-452, 2006

10)Okazaki S, et al：Early statin treatment in patients with acute coronary syndrome；Demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event；The ESTABRISH study. Circulation 110：1061-1068, 2004