Factors Relating to the Reduction in Office Blood Pressure After Repeating Deep Breath
| Autor: | Toshihiko, Ishimitsu, Takeaki, Honda, Chisako, Takahashi, Hiroshi, Satonaka, Yoshio, Iwashima, Akihiro, Tojo |
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| Jazyk: | japonština |
| Rok vydání: | 2022 |
| Předmět: | |
| Zdroj: | Dokkyo Journal of Medical Sciences. 49(1):9-15 |
| ISSN: | 0385-5023 |
| Popis: | 高血圧治療ガイドラインでは，診察室血圧（OBP）は1-2分間隔で測定を繰り返し，安定した2回の測定値の平均で評価することとされているが，数多い高血圧患者の実地診療において測定を繰り返すことは難しく，1回の測定で評価される場合も多い．本研究では診察室血圧が高値を呈する高血圧患者において，深呼吸後に測定を繰り返すことによる血圧の変化を検討した． 外来を受診した高血圧患者で，診察室の収縮期血圧（SBP）140 mmHg 以上を呈した160名を対象とした．1回目の測定の後，深呼吸を繰り返し1-2分後に2回目の測定を行い，血圧の変化に関係する因子を検討した． 1回目のOBP は147/84 mmHg であったが，2 回目は136/82 mmHg と平均11/2 mmHg低下し，69％が非高血圧となった．SBPが10 mmHg以上低下したR群（91 名）と10 mmHg 未満のN群（69 名）の比較では，R群の方が血清クレアチニン（sCr）が低く（1.03 vs 1.36 mg/dL, p＝0.018）血中ヘモグロビン（Hb）が高値（13.9 vs 13.1 g/dL, p＝0.012）で，SBP の低下とHb の間には負の相関が認められた（r＝－0.157, p＝0.046）． SBP が140 未満に低下した110例ではしなかった50例に比べ，家庭血圧で夜のSBPが低く，HbやeGFR（62.3 vs 52.1 mL/分/1.73 m2, p＝0.021）が高値で，sCr やアルブミン尿（124 vs 425 mg/gCr, p＝0.025）が低値であった． 外来加療中の高血圧患者で診察室血圧が高値である場合，特に腎機能低下や蛋白尿がなければ，多くは深呼吸を繰り返すことにより正常化するため，治療方針を決める際に考慮するべきであると思われる． Hypertension treatment guidelines state that office blood pressure should be measured repeatedly at intervals of 1 to 2 minutes and evaluated as the average of two stable measurements. In this study, we examined changes in blood pressure in hypertensive patients with elevated office blood pressure by repeating measurements after deep breathing. One hundred and sixty hypertensive patients who were being treated in the outpatient clinic and presented a systolic blood pressure（SBP）of 140 mmHg or higher in the examination room were included in the study. After the first measurement, a second measurement was taken one to two minutes after repeated deep breathing to examine factors related to blood pressure changes. The first OBP was 147/84 mmHg, but the second was 136/82 mmHg, an average decrease of 11/2 mmHg, and 69％ were non-hypertensive. In a comparison between the group with SBP decrease more than 10 mmHg（91 patients） and the group with SBP decrease less than 10 mmHg（69 patients）, serum creatinine was lower（1.03 vs 1.36 mg/dL, p＝0.018）and blood hemoglobin（Hb）was higher（13.9 vs 13.1 g/dL, p＝0.012）in the decreased group, with a negative correlation between the SBP change and Hb（r＝－0.157, p＝0.046）. Compared to the 50 patients whose SBP were 140 or higher after deep breathing, the 110 patients whose SBP fell below 140 had lower SBP in the evening on home blood pressure, higher Hb, higher estimated glomerular filtration rate（62.3 vs 52.1 mL/min/1.73 m2, p＝ 0.021）, lower serum creatine and lower albuminuria（124 vs 425 mg/gCr, p＝0.025）. In hypertensive outpatients, high office blood pressure is often normalized by repeating deep breath especially in the absence of chronic kidney disease, which should be considered when determining the antihypertensive treatment strategy. |
| Databáze: | OpenAIRE |
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