高齢高血圧症患者の(暫定的)治療指針(米国)

 25日、米国心臓協会(AHA: American Heart Association)と米国心臓病学会(ACC:American College of Cardiology)は合同で expert consensus document(つまりガイドラインではない) という形で高齢者向けの高血圧の初の治療指針を発表しています。

ACCF/AHA 2011 expert consensus document on hypertension in the elderly:
a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents
J Am Coll Cardiol 2011; DOI: 10.1016/j.jacc.2011.01.008. )
http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.01.008
http://content.onlinejacc.org/cgi/reprint/j.jacc.2011.01.008v1.pdf

 詳細は今後医師向けのサイトで紹介される記事を参考にしていただきたいのですが、薬物療法における第一選択はサイアザイド系利尿薬(クロルタリドン、ベンドロフルメチアジド)のようです。

 とりあえず、私たちにも参考となりそうな部分(図・表)をリンクしておきます。

Figure 10 Algorithm for Treatment of Hypertension in the Elderly
http://content.onlinejacc.org/cgi/content-nw/full/j.jacc.2011.01.008v1/FIG10

Table 6 Drug Interactions
http://content.onlinejacc.org/cgi/content-nw/full/j.jacc.2011.01.008v1/TBL6

Table 7 Physiologic Changes With Aging Potentially Affecting the Pharmacokinetics of Antihypertensive Drugs
http://content.onlinejacc.org/cgi/content-nw/full/j.jacc.2011.01.008v1/TBL7

Table 8 Pharmacokinetic Changes, Route of Elimination, and Dosage Adjustment of Selected Antihypertensive Drugs in the Elderly
http://content.onlinejacc.org/cgi/content-nw/full/j.jacc.2011.01.008v1/TBL8

Table 10 Adverse Effects of Antihypertensive Therapy in the Elderly
http://content.onlinejacc.org/cgi/content-nw/full/j.jacc.2011.01.008v1/TBL10

参考:
ACC/AHA issue first clinical guidance for controlling high blood pressure in the elderly
(Eurek Alert! 2011.4.25)
http://www.eurekalert.org/pub_releases/2011-04/acoc-aif042511.php
New Guide for Managing High BP in Seniors
(Medpage TODAY 2011.04.25 要登録)
http://www.medpagetoday.com/Cardiology/Hypertension/26110
New Guidelines: Treat High Blood Pressure in Over-80s
(WebMD 2011.04.25)
http://www.webmd.com/healthy-aging/news/
20110425/new-guidelines-treat-high-blood-pressure-in-over-80s


2011年04月26日 21:37 投稿

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