白衣高血圧の長期予後とバイオフィードバック療法について Long-term White-Coat Hypertension prognosis and EEC Biofeedback Therapy

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高血圧の治療目的は, 高血圧による臓器障害の予防と患者のQua1ityofLife(QOL)の向上にあると言われている.また, 医療環境における随時血圧は高血圧の範疇に入るにもかかわらず, 家庭など非医療環境下で正常血圧である一群は白衣高血圧として広くその概念が知られている.第6次米国高血圧合同委員会報告(1997)では, 非薬物療法の一つとして精神緊張緩和療法[リラクセーションまたはバイオフィードバック療法(BF療法)]を取り上げている.そこで今回, 心因の関与の立場から臓器障害を認めない白衣高血圧にBF療法を導入し, 7年以上長期観察することで臓器障害の予防・QOLの向上にBF療法が効果があるかどうかを検討した.BF療法を20回以上施行した72例のうち7年以上長期観察し得た37例を対象に臓器障害の出現の有無で2群に分け比較した.4年時までは両群とも外来時血圧, 血中カテコラミン値(CA)の有意の低下, 愁訴の改善を認めBF療法は有効であった.しかし, 7年時において臓器障害の出現した群は, 外来時血圧, 不安尺度, CA値の上昇を認めた.白衣高血圧の長期予後からみたBF療法導入の適応は, 愁訴を多く認め, 不安尺度が高値で, α波の基本出現率が50%以上の高値例には積極的に考慮でき, 効果判定には, 外来時血圧の低下だけでなくα波出現率(随意制御)やα波出現の予想的中率(弁別)も加える必要が示された.経過観察には, 外来時血圧, CA値, 不安尺度, α波出現率・予想的中率の推移をみることが示された.

The treatment of hypertension (HT) is presumably designed to prevent hypertension-induced organ disturbances and improve the patients's quality of life (QOL). Though blood pressure (BP) in the medical environment falls under the category of HT, the group of normal BP in the non-medical environment, including families, is broadly known as white-coat hypertension (WHT) in conceptual terms. The 6th report (1997) of the Joint National Committee takes up the relaxation or biofeedback (BF) therapy as a non-pharmaceutical therapy for HT. This time, we used the BF therapy for WHT without any organ disturbances on the assumption that psychogenic factors have something to do with it. By performing more than seven years of observation, we checked and saw if the BF therapy would be of effect in the prevention of organ disturbances and the enhancement of QOL. Of 72 cases to which the BF therapy was provided more than 20 times, 37 placed under more than seven years of observation were divide into two groups, depending on whether they had organ disturbances, and both groups compared. Insofar as four or less years of observation were concerned, the BF therapy turned out to be effective for both groups with significant drops in the values of clinical BP and blood catecholamine (CA) and with improvements in symptoms. In the group with organ disturbances in the seventh year, however, there were rises in clinical BP, in anxiety inventory and in the values of CA. For cases with many symptoms, a high anxiety inventory and the base line of the α-wave at upwards of 50%, the use of the BF therapy should be positively put into consideration, judging from the long-term prognosis of WHT. For an assessment of effects, it was suggested that there was the need to take account of not just a drop in clinical BP but also the correct prediction rate of the α-wave's appearance rate (controllability) and its correct prediction rate (discriminablity). When it comes to observation of the clinical course, it was demonstrated that there was also the need to take into consideration trends in clinical BP, blood CA, the anxiety inventory, controllability and discriminability.

収録刊行物

  • バイオフィードバック研究

    バイオフィードバック研究 27(0), 44-52, 2000

    日本バイオフィードバック学会

被引用文献:  2件中 1-2件 を表示

各種コード

  • NII論文ID(NAID)
    110003162838
  • 本文言語コード
    JPN
  • 資料種別
    雑誌論文
  • ISSN
    0386-1856
  • データ提供元
    CJP引用  NII-ELS  J-STAGE 
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