慢性透析患者の高血圧症に関する臨床研究

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  • Clinical studies of hypertension in patients undergoing regular maintenance hemodialysis
  • マンセイ トウセキ カンジャ ノ コウケツアツショウ ニ カンスル リンショウ
  • 1) comparison of hemodynamic data and plasma renin activity between responsive and resistant hypertension to regular dialysis alone. 2) Beta adrenergic blockade in resistant hypertension
  • 第1報:慢性透析療法により容易に降圧した高血圧症(Responsine hypertension) と降圧しなかった高血圧症(Resistant hypertension)の比較。第2報:慢性透析療法による除水のみでは降圧しなかった高血圧症

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Twenty four out of 78 patients on regular dialysis treatment were normotensive before dialysis (Normotensive group). Among the other 54 hypertensive patients, blood pressure was controlled by sodium restriction and ultrafiltration in 43 patients (Responsive hypertension), but was resistant to these treatments in 9 patients (Resistant hypertension). In order to elucidate the differences of hemodynamic parameters and plasma renin activities (PRA) between responsive and resistant hypertension, serial simultaneous determinations of mean blood pressure (m-BP), blood volume (BY), cardiac index (CI), and PRA were performed. Total peripheral resistant index (TPRI) was calculated from the m-BP/CI in arbitrary units. The results were obtained as follows; 1) Responsive hypertension; Responsive hypertension showed a higher BY and a higher TPRI than those of the normoten-live group, and their blood pressure was easily controlled by the reduction of BY. Therefore, the increase in BY seemed to be responsible for high blood pressure in responsive hypertension. 2) Resistant hypertesion; (a) PRA in resistant hypertension was higher than in responsive hypertension, although its BV was higher than that in the normotensive group. Althouth the reduction of BY decreased CI, it was not able to lower the blood pressure. The reason was, perphaps, due to the increase in PRA. These results suggest that both increased BY and high PRA may contribute to the developp ment of resistant hypertension. (b) In our experience, normal or low BY was not easily maintained in resistant hypertension for a long time because they complained of an insatiable thirst. Therefore, it is possiole that high PRA might be responsible for their complaints of thirst. (c) In resistant hypertension, especially those with high PRA, beta adrenergic blockade low erect blood pressure by reducing TPRI. These findings suggest shat beta adrenergic blockade should be a useful agent for the treatt ment of resistant hypertansion in patients on regular hemodialysis

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