循環器ジャーナル67巻4号

2019年10月発行

特集 冠動脈疾患のリスク管理のフロントライン Ⅱ．冠動脈疾患リスクファクターをどう管理する？

冠動脈疾患の血圧はどこまで下げる？

著者： 甲斐久史¹ 松島慶央¹ 佐々木基起¹

所属機関： ¹久留米大学医療センター循環器内科

ページ範囲：P.585 - P.593

Point
・冠動脈疾患の進展・再発の予防のみならず，心不全や脳卒中などの動脈硬化性心血管疾患の発症予防のために，冠動脈疾患の降圧目標は130/80mmHg未満とする．
・陳旧性心筋梗塞や虚血性心筋症による左室駆出率が低下した心不全では，RA阻害薬・β遮断薬・MR拮抗薬・利尿薬をそれぞれの最大忍容量まで投与するため，降圧目標を一概に定めることはできない．
・個々の症例においては，めまい，ふらつき，たちくらみなどの脳虚血症状や腎機能低下など，忍容性を確認しながら降圧を進める．

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：高血圧治療ガイドライン2019．ライフサイエンス社，2019

2) Okamoto R, Kumagai E, Kai H, et al:Effects of diastolic blood pressure lowering to ＜80mmHg on cardiovascular mortality and events in patients with coronary artery disease:a systematic review and meta-analysis. Hypertens Res 42:650-659, 2019

3) Canty JM:coronary blood flow and myocardial ischemia. In. Robert O. Bonow:Braunwald's Heart Disease 9th Ed. pp.1049-1075, Elsevier, Amsterdam, 2015

4) Rouleau JR, Simard D, Blouin A, et al:Angiotensin inhibition and coronary autoregulation in a canine model of LV hypertrophy. Basic Res Cardiol 97:384-391, 2002

5) Messerli FH, Mancia G, Conti CR, et al:Dogma disputed:can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 144:884-893, 2006

6) Denardo SJ, Messerli FH, Gaxiola E, et al:Coronary revascularization strategy and outcomes according to blood pressure（from the International Verapamil SR-Trandolapril Study［INVEST］）. Am J Cardiol 106:498-503, 2010

7) Kai H, Ueno T, Adachi H, et al:Low DBP may not be an independent risk for cardiovascular death in revascularized coronary artery disease patients. J Hypertens. 29:1889-1896, 2011

8) Kai H, Kimura T, Fukuda K, et al:Impact of low diastolic blood pressure on risk of cardiovascular death in elderly patients with coronary artery disease after revascularization-The CREDO-Kyoto Registry Cohort-1. Circ J 80:1232-1241, 2016

9) Lewington S, Clarke R, Qizilbash N, 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

10) Turnbull F, et al:Effects of different blood-pressure-lowering regimens on major cardiovascular events:results of prospectively-designed overviews of randomised trials. Lancet 362:1527-1535, 2003

11) Xie X, Atkins E, Lv J, et al:Effects of intensive blood pressure lowering on cardiovascular and renal outcomes:updated systematic review and meta-analysis. Lancet 387:435-443, 2016

12) Ettehad D, Emdin 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

13) Bangalore S, Kumar S, Volodarskiy A, et al:Blood pressure targets in patients with coronary artery disease:observations from traditional and Bayesian random effects meta-analysis of randomised trials. Heart 99:601-613, 2013

14) Thompson AM, Hu T, Eshelbrenner CL, et al:Antihypertensive treatment and secondary prevention of cardiovascular disease events among persons without hypertension:a meta-analysis. JAMA 305:913-922, 2011

15) Kai H, Kohro T, Fukuda K, et al:Impact of systolic blood pressure on hemorrhagic stroke in patients with coronary artery disease during anti-platelet therapy:The Japanese Coronary Artery Disease（JCAD）Study. Int J Cardiol 224:112-113, 2016

16) Toyoda K, Yasaka M, Iwade K, et al:Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease:a prospective, multicenter, observational study. Stroke 39:1740-1745, 2008