収縮期高血圧

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of or relating to a systole or happening during a systole

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高血圧[症] / 過度の緊張

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/10 05:42:19」(JST)

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In medicine, systolic hypertension is defined as an elevated systolic blood pressure (SBP).

If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called "isolated systolic hypertension".^[1]^[2]

Causes

Systolic hypertension may be due to reduced compliance of the aorta with increasing age.^[3] This increases the load on the ventricle and compromises coronary blood flow, eventually resulting in left ventricular hypertrophy, coronary ischemia, and heart failure.^[4]

Contemporary science shows an immersed boundary method of computational illustration of a single heartbeat. Applied to physiologic models, immersed boundary theory sees the heart as a great folded semisolid sail fielding and retrieving a viscous blood mass. The sail, likened to Windkessel effect physiology, gives and receives a load under time-ordered phases. Decreasing compliance of the sail heralds the onset of systolic hypertension.

Treatment

The goal of treating systolic hypertension is to delay and reduce the extent of damage to the heart, the cerebrovascular system, and the kidneys. Lifestyle interventions are a crucial element of successful treatment, including a diet low in sodium (salt) and rich in whole grains, fruits, and vegetables. Clinical trials have also documented the beneficial effects of weight loss, increased physical activity, and limiting alcohol consumption.^[4]

In addition to lifestyle changes, medication can also be used to reduce systolic hypertension to safe levels, although medications frequently have side effects, often serious. Two randomized controlled trials have established the value of treating systolic hypertension:^{[citation needed]}

Goal

Based on these studies, treating to a systolic blood pressure of 140, as long as the diastolic blood pressure is 68 or more, seems safe.^{[citation needed]} Corroborating this, a reanalysis of the SHEP data suggests allowing the diastolic to go below 70 may increase adverse effects.^[5]

A meta-analysis of individual patient data from randomized controlled trials found the lowest diastolic blood pressure for which cardiovascular outcomes improve is 85 mm Hg for untreated hypertensives and 80 mm Hg for treated hypertensives.^[6] The authors concluded "poor health conditions leading to low blood pressure and an increased risk for death probably explain the J-shaped curve".^[6] Interpreting the meta-analysis is difficult, but avoiding a diastolic blood pressure below 68–70 mm Hg seems reasonable because:

The low value of 85 mm Hg for treated hypertensives in the meta-analysis is higher than the value of 68–70 mm Hg that is suggested by the two major randomized controlled trials of isolated systolic hypertension
The two largest trials in the meta-analysis, Hypertension Detection and Follow-up Program (HDFP)^[7] and Medical Research Council trial in mild hypertension (MRC1)^[8] were predominantly middle-aged subjects, all of whom had diastolic hypertension before treatment.
The independent contributions of diseases and factors other than hypertension versus effects of treatment are not clear in the meta-analysis.

A more contemporary meta-analysis by the Cochrane Hypertension group found no benefits in terms of reduced mortality or morbidity from treating patients to lower diastolic targets than 90 - 100mmHg.^[9]

Newer treatments have emerged since these trials, which address the underlying causes of hypertension in novel ways. For instance, a direct inhibitor of the kidney hormone renin, called aliskiren, has recently been released in the United States. It has antihypertensive efficacy similar to ACE inhibitors and angiotensin receptor blockers. By suppressing renin activity directly rather than indirectly (as these other medications do), it avoids a rebound in renin levels that gradually interferes with their efficacy.^[4] Over the long term, though, it may lead to increases in the physiological precursor of renin. Its role as a single agent without the concomitant use of other antihypertensives is not yet clear.^[10]

Medications that act on the sympathetic nervous system, which is important in the cause of hypertension, also show promise. European studies show selective imidazoline agonists, such as moxonidine and rilmenidine, are reasonably effective against hypertension while improving glucose tolerance and lipid metabolism.^[4]

References

^ "Isolated systolic hypertension: A health concern? - MayoClinic.com". Retrieved 2008-12-22.
^ "The Cleveland Clinic Center for Continuing Education". Retrieved 2008-12-22.
^ Smulyan H, Safar ME (February 2000). "The diastolic blood pressure in systolic hypertension". Ann. Intern. Med. 132 (3): 233–7. doi:10.7326/0003-4819-132-3-200002010-00010. PMID 10651605.
^ ^a ^b ^c ^d DeLoach, SS; Townsend, RR (March 2008). "Systolic Hypertension: A Guide to Optimal Therapy". Consultant 48 (3).
^ Somes GW, Pahor M, Shorr RI, Cushman WC, Applegate WB (September 1999). "The role of diastolic blood pressure when treating isolated systolic hypertension". Arch. Intern. Med. 159 (17): 2004–9. doi:10.1001/archinte.159.17.2004. PMID 10510985.
^ ^a ^b Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP (2002). "J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data". Ann. Intern. Med. 136 (6): 438–48. doi:10.7326/0003-4819-136-6-200203190-00007. PMID 11900496.
^ , (1979). "Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. Hypertension Detection and Follow-up Program Cooperative Group". JAMA 242 (23): 2562–71. doi:10.1001/jama.242.23.2562. PMID 490882.
^ "MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party". British medical journal (Clinical research ed.) 291 (6488): 97–104. 1985. doi:10.1136/bmj.291.6488.97. PMC 1416260. PMID 2861880.
^ Arguedas JA, Perez MI, Wright JM. Treatment blood pressure targets for hypertension. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004349. DOI: 10.1002/14651858.CD004349.pub2.
^ Vidt, DG (January 2008). "What's New in the Treatment of Hypertension?". Consultant 48 (1).

UpToDate Contents

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1. 高齢者における高血圧、特に収縮期高血圧の治療 treatment of hypertension in the elderly patient particularly isolated systolic hypertension
2. 高血圧：誰が治療が必要か？ hypertension who should be treated
3. 脈圧の上昇 increased pulse pressure
4. 本態性高血圧における治療選択：推奨 choice of therapy in essential hypertension recommendations
5. アテローム性心血管疾患患者における血圧マネージメント blood pressure management in patients with atherosclerotic cardiovascular disease

English Journal

Computational fluid dynamics simulation to evaluate aortic coarctation gradient with contrast-enhanced CT.

Rinaudo A1, D'Ancona G, Baglini R, Amaducci A, Follis F, Pilato M, Pasta S.
Computer methods in biomechanics and biomedical engineering.Comput Methods Biomech Biomed Engin.2015 Aug;18(10):1066-1071. Epub 2014 Jan 27.
Coarctation of aorta (CoA) is a narrowing of the aorta leading to a pressure gradient (ΔP) across the coarctation, increased afterload and reduced peripheral perfusion pressures. Indication to invasive treatment is based on values of maximal (systolic) trans-coarctation ΔP. A computational fluid d
PMID 24460213

Antihypertensive effect of the bovine casein-derived peptide Met-Lys-Pro.

Yamada A1, Sakurai T2, Ochi D2, Mitsuyama E2, Yamauchi K2, Abe F2.
Food chemistry.Food Chem.2015 Apr 1;172:441-6. doi: 10.1016/j.foodchem.2014.09.098. Epub 2014 Sep 28.
The antihypertensive effect of the bovine casein-derived peptide Met-Lys-Pro (MKP) was examined in vitro and in vivo. MKP showed angiotensin I-converting enzyme (ACE)-inhibitory activity in vitro (IC50=0.43μM). An in vivo kinetics study using radiolabeled Met-[1-(14)C]Lys-Pro ((14)C-MKP) showed tha
PMID 25442576

Nine novel angiotensin I-converting enzyme (ACE) inhibitory peptides from cuttlefish (Sepia officinalis) muscle protein hydrolysates and antihypertensive effect of the potent active peptide in spontaneously hypertensive rats.

Balti R1, Bougatef A2, Sila A3, Guillochon D3, Dhulster P3, Nedjar-Arroume N3.
Food chemistry.Food Chem.2015 Mar 1;170:519-25. doi: 10.1016/j.foodchem.2013.03.091. Epub 2013 Apr 12.
This study aimed to identify novel ACE inhibitory peptides from the muscle of cuttlefish. Proteins were hydrolyzed and the hydrolysates were then subjected to various types of chromatography to isolate the active peptides. Nine ACE inhibitory peptides were isolated and their molecular masses and ami
PMID 25306378

Japanese Journal

BLOOD PRESSURE OF BAKA PYGMIES LIVING IN SOUTHEASTERN CAMEROON

Kyohei KAWAMURA Taro YAMAUCHI Koji HAYASHI Hiroaki SATO
African study monographs. Supplementary issue 47, 35-44, 2014-03-20
… There were no differences in systolic/diastolic BP in the Baka Pygmies with respect to the sex. … A comparison of BP showed that neither systolic nor diastolic BP increased with age in Baka Pygmies, but it increased in the Y group (from 20 to 60 years). … The average systolic/diastolic BP in Baka Pygmies (122.8 ± 10.9/71.2 ± 8.6 mmHg) was significantly lower than that of the H and the Y groups (126.1 ± 17.5/80.3 ± 11.3 and 131.6 ± 15.4/78.8 ± 9.9 mmHg, respectively). …
NAID 110009687651

Blood Press ure of Baka Pygmies Living in Southeastern Cameroon

KAWAMURA Kyohei,YAMAUCHI Taro,HAYASHI Koji,SATO Hiroaki
African study monographs. Supplementary issue. 47, 35-44, 2014-03
… T here were no differences in systolic/diastolic BP in the Baka Pygmies with respect to the sex. … A comparison of BP showed that neither systolic nor diastolic BP increased with age in Baka Pygmies, but it increased in the Y group (from 20 to 60 years). … The average systolic/diastolic BP in Baka Pygmies (122.8 ± 10.9/71.2 ± 8.6 mmHg) was significantly lower than that of the H and the Y groups (126.1 ± 17.5/80.3 ± 11.3 and 131.6 ± 15.4/78.8 ± 9.9 mmHg, respectively). …
NAID 120005399073

Association of Blood Pressure and Body Mass Index with Intraocular Pressure in Middle-aged and Older Japanese Residents:A Cross-sectional and Longitudinal Study

Yoshida Masao,Ishikawa Mamoru,Karita Kanae,Kokaze Akatsuki,Harada Matsuko,Take Shinichiro,Ohno Hideki
Acta Medica Okayama 68(1), 27-34, 2014-02
… This epidemiologicalstudy analyzed health examination data obtained between 2001 and 2005 from 896 Japanese individuals (aged 32-79 years) who had not undergone any ocular surgery or medical treatment for hypertension, ocular hypertension, or glaucoma. … Multiple-regression analysis of our cross-sectional data showed that systolic and diastolic BP (SBP and DBP) and BMI had significant and near-significantpositive associations with IOP in men (p＜0.05) and women (p＜0.1). …
NAID 120005372643