埼玉医科大学雑誌

埼玉医科大学雑誌第30巻第1号 (2003年1月) 51-60頁 ◇論文(図表を含む全文)は，PDFファイルとなっています．

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原　著
閉経後高血圧の診断方法と治療法の検討

小林　和裕
埼玉医科大学腎臓内科学教室〔平成14年12月10日受付〕

Study For Examining of Evaluation of Blood Pressure (BP) and Investigation of Hypertensive Therapy in Postmenopausal Women
Kazuhiro Kobayashi (Department of Nephrology, Saitama Medical School, Moroyama, Iruma-gun, Saitama 350-0495, Japan)

Study I: This study was carried out to determine whether non-invasive assessment of cardiovascular system discriminates white coat hypertension (WCH). The major reason is the high prevalence of WCH in these subjects and it remains uncertain whether WCH is associated with cardiovascular risk. Women were required to be naturally menopausal; at least 1 year, but not greater than 5 years, past their menstrual period. Exclusion criteria were past history of preeclampsia or eclampsia, severe illness such as myocardial infarction and stroke within 6 months, having used estrogens or progestins within 3 months, being treated with antihypertensive agents or with non pharmacological therapy such as reduction of daily salt, and proteinuric nephropathy. In addition, secondary hypertension was excluded as possible. WCH was defined if subjects who had BP more than 150/90 mmHg at office had to have both mean systolic and diastolic pressures below 120/80 mmHg at home. Forty-four subjects, mean age 52 years, recruited from the outpatients clinic, were examined. BPs at office and home, pulse wave velocity (PWV), and augmentation index (Aix) were recorded. Left ventricular diameter, septal wall thickness, and left posterior wall thickness were assessed by M-mode echocardiography after selecting the measurement section by B-mode echocardiography. Twenty patients were diagnosed as having WCH based on the criteria in the trial. We found that the patterns of pulse wave were different between subjects with WCH and those with hypertension. The most prominent difference was the levels of Aix. In subjects with WCH, Aixs were 25.6±3.8 compared to 38.6±4.5 mmHg in those with hypertension. Moreover, PWV of subjects with WCH were 6.05±0.53 and those of with hypertension were 8.45±0.72 m/sec (p＜0.01). In addition to these findings, there was a significant association between the values of home systolic BP but not those of office systolic BP and PWV, Aix and LV mass index. When we combined the data of LV mass index and Aix, white coat hypertension was easily segregated from hypertension. The combination of self BP monitoring, echocardiographic data and Aix and PWV would be powerful indicators for treatment of hypertension in postmenopausal women.
Study II: To assess the efficacy of the various classes of antihypertensive drugs in postmenopausal women with hypertension. Women were required to be naturally menopausal; at least 1 year, but not greater than 5 years, past their menstrual period. Exclusion criteria were past history of preeclampsia or eclampsia, severe illness such as myocardial infarction and stroke within 6 months, having used estrogens or progestins within 3 months, and proteinuric nephropathy as well as surgically menopausal. 114 women who participated in this study after informed consent were obtained. These women were diagnosed as having hypertension based on BP of more than 140/90 mmHg at clinic as well as on self-reported BP of more than 130/85 mmHg at home. If both levels of BP were not satisfied with the criteria, such patients were also excluded. All antihypertensive medications were withdrawn 6 weeks before the initiation of the study. All patients were randomly assigned in equal numbers to the following therapeutic groups; A) losartan, 50 mg daily and trichlormethiazide 2 mg twice a week and B) cilnidipine, a calcium channel blocker, 5 mg and arotinolol, an αβ blocker, 10 mg daily. Three groups were retrospectively segregated according to pulse pressure (PP) at the start of the study: Group I (n＝ 24); more than 65 mmHg: Group II (n＝58); below 64 to more than 45 mmHg and Group III (n＝32); below 44 mmHg. In Group I, combination therapy with B) reduced systolic BP much more compared to that with A) (169±2/88±5 to 133±2/73±5 vs 169±2/88±5 to 149±2/66±5 mmHg, p＜0.05). On the other hand, in Group III, A) decreased diastolic BP as well as systolic BP (152±2/106±2 to 123±1/78±1 vs 149±2/107±2 to 129±2/84±1 mmHg, p＜0.05). In Group II, there was no significant difference between two antihypertensive regimens. Other three biological markers were not influenced by any type of treatment. PP before starting medication of hypertension may be useful for the choice of antihypertensive drugs.
Combining these two studies, it is suggested that evaluation and treatment of hypertensive postmenopausal women would be much more investigated than previously and be needed much work to be carried out.
Keywords: White coat hypertension, Pulse wave velocity, Pulse pressure
J Saitama Med School 2003;30:51-60
(Received December 10, 2002)

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