診療所の血圧ではなく,平均日々の血圧が,高血圧患者の心臓機能を決定する

W B White¹, P Schulman, E J McCabe

¹Section of Hypertension, University of Connecticut School of Medicine, Farmington 06032.

JAMA

|February 10, 1989

まとめ

オフィスでの高血圧,または医師の診察室でのみ高血圧は,心臓病の原因には見えない. 歩行式血圧モニタリングは,高血圧患者の心臓損傷を予測する鍵です.

科学分野:

心臓病学心臓病学
高血圧の研究高血圧の研究
診断医学診断医学

背景:

高血圧は心臓病の重要な危険因子です.
診察室と診察室外の血圧測定値の不一致は,診断を複雑にすることがあります.
隔離されたオフィス高血圧の患者の心臓状態を評価するには,さらなる調査が必要です.

研究の目的:

異なる血圧測定値を持つ高血圧患者の心臓病の存在を調査するために.
診療室での高血圧の患者における心臓の構造と機能を,昼間の高血圧と正常血圧の患者と比較する.
心臓の末端器官損傷に対する異なる血圧測定方法の予測値を決定する.

主な方法:

年齢を合わせた3つの患者グループ:オフィス高血圧患者,ノルモテンシブ患者,昼間の高血圧患者による前向きな研究.
カジュアル (オフィス) と覚醒状態の ambulatory 血圧測定に基づいて分類する.
左心室指数,左心室質量指数,左心室充填率,射出分数を含む心臓のパラメータの評価.

主要な成果:

診療室での高血圧の患者は,昼間の高血圧患者と比較して,左心房および左心房の質量指数が有意に低下した.
オフィス高血圧患者の心臓機能 (充填率,エジェクション分数) は,ノルモテンシブと類似しており,昼間の高血圧患者よりも優れていた.
診療室での高血圧患者と正常血圧患者の間で,心臓のサイズと機能の有意な違いは認められなかった.

結論:

医者の診察室でのみ血圧上昇は,正常血圧の個人に比べて心臓のサイズと機能と関連しています.
平均日々の血圧を反映した歩行式血圧モニタリングは,診察室での測定値のみよりも,心臓の末端器官損傷のより信頼性の高い予測指標です.
正確な高血圧診断とリスクの階層化は,診療室外での血圧測定を含めるべきです.

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