神経性高血圧症の予後と治療 : 主として循環動態からみた根本的な二,三のこと(第31回千葉医学会総会特別講演)

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Neurogenic is meant here by fully compensated essential hypertension in which neurogenic factors might play possibly important role. Such an essential hypertension may be defined functionally as elevated blood pressure associated with a normal cardiac output and an augumented peripheral resistance. The peripheral resistance is calculated as follows: R.=B.P.m/C.O.×1332 Where B.P.m., mean arterial pressure in mmHg; C.O., cardiac output in cc per sec.; 1332, the conversion factor from mmHg to dynes/cm^2. Both Fick-Cournand's and Wezler-Boger's methods are performed at the same time in our observations. The mean pressure is estimated by direct arterial punction, recording damped pressure, or by integrating the area under the pressure tracing curve. On the bed rest, the blood pressure of the hypertensive cases may be suppressed as a result of a decrease of cardiac output to subnormal range, while the peripheral resistance remains the same, or as a result of a diminution in peripheral resistance, while the cardiac output remains the same. There exists also a sort of patients with normal blood pressure, low cardiac output and augumented peripheral resistance. Such a condition is seen in patients with various kinds of cardiac disease, for instance, left ventricular failure including hypertension itself, mitral stenosis, cor pulmonale, a-v shunt etc. Systolic hypertension from rigid vascular wall or atherosclerosis is of course a common concomitant or complication of high blood pressure. It is of practical significance to the clinicians to be able to ascertain its presence because most of all autonomic blocking agents do not improve this condition. As the simple diagnostic mean to suspect a systolic hypertension, Dexter's formula may be recommended, relating pulse pressure to diastolic pressure. Its accuracy is examined by means of Fick-Cournand andWezler-Boger's methods. Though the attitude of a blood pressure is analyzed in the above fashion, no clear cut difinition of hypertensive disease is yet apparently tenable.If both pressure and peripheral resistance are increased or if ocular, cardiac and renal stigmata are present with or without hypertension, then hypertensive disease can be assumed to exist. For the practitioner, it may be thought that the etiological classification of Braun-Menendez et al or of Page and Corcoran in their monographs is the most complete that exists. Moreover, Page and Corcoran have devised also a very useful prognotic classification for clinician of which I approve completely in principle. From my. colleagues ; results it can be elucidated that Page's classification serves a defferent prognosis from Keith-Wagener's based upon merely the state of eye-ground. Finally, action mode of new vaso-depressant autonomic blocking agents, such as C_5 pendiomide, 1-hydrazinophthalazine, Rauwolfia preparates and Regitine, are discussed from pharmacodynamical and clinical viewpoints.
千葉大学の論文
1955-01-28

神経性高血圧症の予後と治療 : 主として循環動態からみた根本的な二,三のこと(第31回千葉医学会総会特別講演)

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