検査と技術38巻11号

2010年10月発行

けんさ質問箱

血圧の日内変動の因子は?

著者： 玉置昇¹ 苅尾七臣²

所属機関： ¹たまきクリニック ²自治医科大学内科学講座　循環器内科学部門

ページ範囲：P.1094 - P.1102

Q.血圧の日内変動の因子は?

血圧には日内変動がありますが，食事など測定値に影響する因子について教えて下さい．(福岡市　K.Y.生)


A玉置　昇^＊1・苅尾七臣^＊2
はじめに

　24時間で心臓は約10万回収縮を繰り返しているため，理論上は1日に10万回血圧を測定可能ということになる．元来，動物には概日リズム〔サーカディアンリズム(circadian rhythm)〕という外界からの刺激がなくても約24時間の周期で睡眠，血圧などのパターンを規定する内在性因子が存在する．一般に血圧は睡眠中に最も低く，起床前から起床後に上昇し，夕方から夜にかけて低下するという一定のリズムを刻んでいる．さらに血圧にはサーカディアンリズム以外に，以下に述べるようなさまざまな生活環境因子，生活習慣などが影響し，絶えず変動している．高血圧は心血管疾患の最大のリスクであり，血圧の変動がさらに心血管イベントのリスク増大と関連していることが報告されている^1）．診察室血圧以外に家庭血圧を測定することは血圧の評価において有用である^2）が，血圧の日内変動を知るためには，24時間自由行動下血圧測定(ambulatory blood pressure monitoring，ABPM)が必要である．JSH2009では24時間にわたる血圧管理，家庭血圧の重要性が示され^3），ABPMはさらに有力な検査手段となった．本稿では血圧の日内変動に影響を及ぼす因子とその意義について概説したい．

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