新しい降圧薬の血行力学的薬効分析 : β遮断薬,Ca拮抗薬,降圧利尿薬について

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タイトル別名
  • アタラシイ コウアツヤク ノ ケッコウ リキガクテキ ヤッコウ ブンセキ ベー
  • Hemodynamic Effects of New Antihypertensive Agents : A Comparison of β-blockers, Calcium Antagonists and Diuretics
  • 原著

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説明

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本態性高血圧症107例にβ遮断薬,Ca拮抗薬,降圧利尿薬のいずれかを単独で使用し,前および3カ月後に血行動態的測定を行ない,一部症例では約6カ月後にも同様の測定を行なった。測定は安静臥位30分後,血圧,心拍出量,左室収縮期時相分析値,全末梢抵抗および脈管容積弾性率をもとめた。心拍出量は色素希釈法を用い,心脈管力学的数値はHolldak法およびWezler法を用いて求めた。また大部分の症例で,治療開始前にfurosemide立位負荷試験を行ない血漿レニン活性(PRA)を測定した。降圧薬使用前後の血行動態の変化は,平均血圧13mmHg以上の降圧を示した例のみについてまとめた。その結果,薬剤使用前後の血行動態の主な変化は,β遮断薬と降圧利尿薬では心拍出量の減少であり,Ca拮抗薬では全末梢抵抗の減少であった。高血圧を血行動態から高心拍出量型と全末梢抵抗増大型に,さらにPRAから,高,正,低レニン群に分けて降圧薬の適応を検討した。その結果,高心拍出量型では,高レニン群でβ遮断薬,正レニン群でβ遮断薬または降圧利尿薬,低レニン群で降圧利尿薬が,全末梢抵抗増大型では,高レニン,正レニン,低レニンいずれの群でもCa拮抗薬が適応となることが明らかとなった。以上より降圧薬使用に際しては単に血圧を下げるのみでなく,血行動態およびPRAなどを考慮して,最善の薬剤を選ぶべきであると考える。

One hundred and seven patients with essential hypertension were treated with either a beta-blocker, a calcium antagonist or a diuretic anti-hypertensive agent, and non-invasive hemodynamic assessment was obtained before and after 3 months of treatment. Some cases were studied after 6 months of treatment as well. The study included measurements of blood pressure, cardiac output, systolic time intervals, total peripheral resistance and volume-elasticity index. The cardiac output was measured by the dye-dilution method and the cardiovascular dynamic parameters were obtained by Holldack method and by Wezler method. Plasma renin activity (PRA) was measured with furosemide-loading test before the treatment. The patients were classified into the high-vascular resistance group and the high-cardiac output group based on the hemodynamic characteristics, and each group was further divided into high-renin, nor-morenin and low-renin group according to the PRA. Only patients who had a fall of the mean blood pressure more than 13 mmHg after the treatment were included in the analysis. The main hemodynamic change following the treatment with beta-blockers or diuretics was a decrease of cardiac output and that with calcium antagonists was a decrease of the total peripheral resistance. In the high-cardiac output group, the high-renin group responded best to beta-blockers, the normo-renin group to either beta-blockers or diuretics and the low-renin group to diuretics. The high-vascular resistance group responded best to calcium antagonists regardless the PRA. Thus, cardiovascular dynamic study and PRA were found very useful for the selection of the anti-hypertnesive drugs. And they should be included in the initial assessment of hypertensive patients.

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