特集名 | 透析患者における高血圧と低血圧 | |
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題名 | Ambulatory blood pressure monitoring (ABPM) の有用性 | |
発刊年月 | 2003年 02月 | |
著者 | 岡野 正裕 | 天塩町立国民健康保険病院外科 |
【 要旨 】 | 血液透析患者では夜間高血圧を呈する症例が多く,透析前・後で血圧の日内変動パターンが異なり,93%の症例に血圧日内変動異常を認めた.44例(男:女=24:20)を対象に,透析前・後48時間の自由行動下血圧(ABP)測定を施行した.平均年齢64歳,平均透析歴65カ月,透析前・後では血圧値(24時間ABP)に有意な変化はなく,透析後17時間ABPは有意に下降した.分析した症例中,5%がextreme-dipper(夜間血圧降圧度20%以上),7%がdipper(10~20%)であった.39%がnon-dipper(0~10%未満)例であり,CTR,ナトリウム利尿ペプチド,カテコールアミンの上昇が認められた.50%がinverted-dipper(0%未満)であった.透析間日の体重増加が夜間降圧の妨げになっていると思われた. |
Theme | Hypertension and Hypotension in Patients with Maintenance Dialysis -- Mechanisms and Therapeutic Approach | |
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Title | Efficacy of ambulatory blood pressure monitoring (ABPM) | |
Author | Masahiro Okano | Tesio Municipal National Health Insurance Hospital |
[ Summary ] | Hemodialysis (HD) patients often have nocturnal hypertension, related to different circadian blood pressure patterns, preceding and following HD sessions, resulting in a 93% abnormality rate. ABPM was performed over a 48-hour period on forty-four HD patients, 64 years old, who had been on HD for a mean average of 65 months. There was no significant change in 24-hour ABP pre-or post-HD, but there was a significant decline in 17-hour ABP, post-HD. 5% of subjects displayed extreme-dipper, 7% dipper and 50% inverted-dipper, CTR, plasma concentrations of natriuretic peptides and catecolamine rose in non-dipper, 39% of subjects. Interdialytic weight gain causes poor reproducibility of nocturnal BP decline. |