medicina57巻10号

2020年09月発行

特集 循環器診療2020—どこまで攻めて，どこから引くか？ 予防医療

血圧も積極的に下げる！ただ結局そのカットオフはどうなった？

著者： 大澤正樹¹²

所属機関： ¹特定医療法人盛岡つなぎ温泉病院内科 ²岩手医科大学医学部内科学講座循環器内科分野

ページ範囲：P.1646 - P.1652

Point
◎集団平均値で得られた血圧管理目標値は，患者個人の血圧管理にとってあくまで参考値である．
◎白衣高血圧や血圧変動の大きな個人には，ガイドラインの血圧管理目標値をそのまま適用することは危険である．
◎75歳未満かつ高血圧症以外の危険因子をもたない個人では，厳格な降圧治療を慎重に行う価値がある．
◎糖尿病患者，および75歳以上の高齢者では血圧値120〜139/80〜89mmHgを管理目標値とすべきである．

参考文献

1）Dawber TR, et al：Coronary heart disease in the Framingham study. Am J Public Health Nations Health 47：4-24, 1957

2）Intersalt；An international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Intersalt Cooperative Research Group. BMJ 297：319-328, 1988

3）Mancilha-Carvalho JJ, et al：Blood pressure and electrolyte excretion in the Yanomamo Indians, an isolated population. J Hum Hypertens 3：309-314, 1989

4）Lewington S, et al：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

5）Mancia G, et al：2007 Guidelines for the Management of Arterial Hypertension：The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension（ESH）and of the European Society of Cardiology（ESC）. J Hypertens 25：1105-1187, 2007

6）Group AS, et al：Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362：1575-1585, 2010

7）Group SR, et al：A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373：2103-2116, 2015

8）Patel A, et al：Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus（the ADVANCE trial）；A randomised controlled trial. Lancet 370：829-840, 2007

9）SPS3 Study Group, et al：Blood-pressure targets in patients with recent lacunar stroke；The SPS3 randomised trial. Lancet 382：507-515, 2013

10）Lonn EM, et al：Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 374：2009-2020, 2016

11）Krakoff LR：A tale of 3 trials；ACCORD, SPRINT, and SPS3. What happened? Am J Hypertens 29：1020-1023, 2016

12）Sundstrom J, et al：Blood pressure levels and risk of cardiovascular events and mortality in type-2 diabetes；Cohort study of 34 009 primary care patients. J Hypertens 31：1603-1610, 2013

13）Vamos EP, et al：Association of systolic and diastolic blood pressure and all cause mortality in people with newly diagnosed type 2 diabetes；Retrospective cohort study. BMJ 345：e5567, 2012

14）Cederholm J, et al：Blood pressure and risk of cardiovascular diseases in type 2 diabetes；Further findings from the Swedish National Diabetes Register（NDR-BP Ⅱ）. J Hypertens 30：2020-2030, 2012

15）Xie X, et al：Effects of intensive blood pressure lowering on cardiovascular and renal outcomes；Updated systematic review and meta-analysis. Lancet 387：435-443, 2016

16）Lonn EM, et al：Blood-pressure and cholesterol lowering in the HOPE-3 Trial. N Engl J Med 375：1193-1194, 2016

17）Mancia G, et al：Cardiovascular outcomes at different on-treatment blood pressures in the hypertensive patients of the VALUE trial. Eur Heart J 37：955-964, 2016

18）Kjeldsen SE, et al：HOPE-3, SPRINT, VALUE and a meta-analysis of trials in patients with diabetes support treatment of hypertension to a target below 140 mmHg. Blood Press 25：131-132, 2016

19）Filipovsky J, et al：Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients. Blood Press 25：228-234, 2016

20）Gosmanov AR, et al：Synergistic association of combined glycemic and blood pressure level with risk of complications in US veterans with diabetes. J Hypertens 34：907-913, 2016

21）Yusuf S, Lonn E：The SPRINT and the HOPE-3 Trial in the context of other blood pressure-lowering trials. JAMA Cardiol 1：857-858, 2016

22）Whelton PK, et al：Comparing the SPRINT and the HOPE-3 Blood Pressure Trial. JAMA Cardiol 1：855-856, 2016

23）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2019.日本高血圧学会，2019

24）Fujiyoshi A, et al：Blood pressure categories and long-term risk of cardiovascular disease according to age group in Japanese men and women. Hypertens Res 35：947-953, 2012