循環器ジャーナル66巻1号

2018年01月発行

特集 循環器診療　薬のギモン—エキスパートに学ぶ薬物治療のテクニック Ⅱ．高血圧診療でのギモン

収縮期血圧140mmHg．薬剤を追加して下げるべきか？

著者： 斎藤重幸¹

所属機関： ¹札幌医科大学保健医療学部基礎臨床医学講座

ページ範囲：P.48 - P.57

Point
・現在の日本人においても高血圧は生命予後，ADL，QOLを規定する最大のリスク因子の一つである．
・高血圧の診療にはガイドライン（JSH2014）の利用が有用で，個々の病態を踏まえた治療・管理が必要となる．
・高血圧治療では確実な降圧が達成できなければ，予後改善効果は得られない．忍容性を考慮して確実な降圧を得ること．

参考文献

1) 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2014（JSH2014），ライフサイエンス出版，東京，日本高血圧学会，2014

2) Lawer CM, Rodgers A, Bennett DA, et al:Asia Pacific Chort Studies Collaboration. Blood pressur and cardiovasucular disease in the Asian Pacific region. J Hypertens 21:707-716, 2003

3) Murakami Y, Hozawa A, Okamura T, et al:Evidence for Cardiovascular Prevention From Observational Cohorts in Japan Research Group（EPOCHJAPAN）. Relation of blood pressure and all-cause mortality in 180, 000 Japanese participants:pooled analysis of 13 cohort studies. Hypertens 51:1483-1491, 2008

4) Arima H, Tanizaki Y, Kiyohara Y, et al:Validity of the JNC Ⅵ recommendations for the management of hypertension in a general population of Japanese elderly:the Hisayama study. Arch Intern Med 163:361-366:2003

5) Takagi S, Saitoh S, Nakano M, et al:Relationship between blood pressure level and mortality rate:an 18-year study conducted in two rural communities in Japan. J Hypertens 18:143-148, 2000

6) Nomura K, Asayama K, Thijs L, et al:International Database of Home Blood Pressure in Relation to Cardiovascular Outcome（IDHOCO）Investigators. Thresholds for conventional and home blood pressure by sex and age in 5018 participants from 5 populations. Hypertens 64:695-701, 2014

7) Law MR, Morris JK, Wald NJ, et al:Use of blood pressure lowering drugs in the prevention of cardiovascular disease:meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338:b1665, 2009

8) Staessen JA, Gasowski J, Wang JG, et al:Risks of untreated and treated isolated systolic hypertension in the elderly:meta-analysis of outcome trials. Lancet 355:865-872, 2000

9) Bejan-Angoulvant T, Saadatian-Elahi M, Wright JM, et al:Treatment of hypertension in patients 80 years and older:the lower the better? A metaanalysis of randomized controlled trials. J Hypertens 28:1366-1372, 2010

10) Asayama K, Ohkubo T, Yoshida S, et al:Japan Arteriosclerosis Longitudinal Study（JALS）group. Stroke risk and antihypertensive drug treatment in the general population:the Japan arteriosclerosis longitudinal study. J Hypertens 27:357-364, 2009

11) Lonn EM, Bosch J, Jaramillo PL, et al:Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med 374:2009-2020, 2016

12) SPRINT Research Group:A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373:2103-2116, 2015

13) Filipovský J, Seidlerová J, Kratochvíl Z, et al:Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients. Blood Press 25:228-234, 2016

14) Ikeda N, Saito E, Kondo N, et al:What has made the population of Japan healthy? Lancet 378:1094-1105, 2011

15) Turin TC, Murakami Y, Miura K, et al:Combined cardiovascular risk factors and outcome:NIPPON DATA80, 1980-1994. Circ J 70:960-964, 2006

16) Athanase B, Frédérique T, Kathryn EB, et al:Why cardiovascular mortality is higher in treated hypertensives versus subjects of the same age, in the general population. J Hypertens 21:1635-1640, 2003

17) Ettehad D, Midim CA, Kiran A, et al:Blood pressure lowering for prevention of cardiovascular disease and death:a systematic review and meta-analysis. Lancet 387:957-967, 2016

18) Weiss J, Freedom M, Low A, et al:Benefits and Harms of Intensive Blood Pressure Treatment in Adults Aged 60 Years or Older:A Systematic Review and Meta-analysis. Ann Intern Med 166:419-429, 2017