ラクナ梗塞患者における降圧薬投与による血圧日内変動の検討　　Ｎｉｌｖａｄｉｐｉｎｅ投与による検討

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  • Changes of blood pressure variation patterns after Nilvadipine administration in patients with lacunar infarction.
  • Nilvadipine投与による検討

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Recent studies based on 24-hour blood pressure measurements in hypertensive patients have revealed that variations occur in the patterns of changes. Such variations include patients with a normal fall in nocturnal blood pressure (dippers), patients with only a slight fall in nocturnal blood pressure (non-dippers), and patients with an elevation in nocturnal blood pressure (reversed cases). Patients with abnormal blood pressure variation patterns tend to have a poorer prognosis as well as more extensive hypertensive organ disease. It is important therefore to determine how blood pressure should be controlled throughout the 24-hour period in such patients. We have observed unique blood pressure control patterns in lacunar infarct patients who were administered Nilvadipine.<BR>We examined 35 patients with lacunar infarction who were admitted to our hospital. All patients underwent 24-hour blood pressure measurements during the period more than 4 weeks after ictus. Nilvadipine was then administered and, after 8 to 12 weeks of Nivaldipine treatment, 24-hour blood pressure measurements were recorded. The patients were subsequently divided into three groups : 13 patients with a dipple pattern, 11 with a non-dipper pattern, and 11 with a reversed pattern. Eleven of the patients with non-dipper and reversed patterns undewent cerebral blood flow measurements employing 123 IMP, SPECT before and after Nilvadipine had been given.<BR>Following Nilvadipine treatment, the daytime and night-time blood pressure was controlled as follows. In dippers, the daytime systolic blood pressure (SBP) was significantly decreased (from 161.7±16.2 mmHg to 150±10.6 mmHg, p<0.05), while the daytime diastolic blood pressure (DBP) and night-time SBP and DBP were not significantly decreased. In non-dippers, significant decreases were noted in both the night-time SBP (from 151.4±11.2 mmHg to 135.6±8.6 mmHg, p<0.01) and night-time DBP (from 81.2±5.7 mmHg to 74.2±8.4 mmHg, p<0.05), while there were no significant decrases in the daytime SBP or DBP. In reversed cases, the night-time SBP was significantly decreased (from 165.3±16 mmHg to 147.1±14.7 mmHg, p<0.05), whereas the hight-time DBP and daytime blood pressure were not significantly decreased.<BR>After Nivaldipine had been administered to the above-mentioned group of 11 patients including non-dippers and reversed cases, the cerebral blood flow was significantly increased from 45.9±6.1 to 49.5±7.0 (ml/100 mg/min), and the night-time blood pressure was significantly decrased. After Nivaldipine had been administered to the 11 non-dipper patients, the correlation between SBP and heart rate was improved.<BR>The observed blood pressure control patterns can be summarized as follows : the blood pressure was decreased mainly in the daytime in dippers, and decreased mainly in the night-time in non-dippers and reversed pattern cases. It is worthy of note that the non-dipper pattern converted into a dipper pattern following Nilvadipine administration. We speculate that the central autonomic nervous function might play a role in such conversion from a non-dipper to dipper pattern. Normal function of the central autonomic nervous system was considered to have been restored. An increased cerebral blood flow and improved correlation between SBP and heart rate after Nilvadipine administration would tend to support this hypothesis.<BR>Different blood pressure control patterns based on 24-hour variations in blood pressure were thus detected. Since the degree to which the night-time blood pressure should be controlled remains to be determined, further examinations of these variations is required.

収録刊行物

  • 脳卒中

    脳卒中 19 (3), 193-202, 1997

    一般社団法人 日本脳卒中学会

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