老年者における高血圧症の循環分析
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概要
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It is commonly said, that in so-called senile arterial hypertension the systolic blood pressure is particularly augmented in contrast to the diastolic. This phenomenon is considered to depend upon the increase in the elastic resistance of larger arteries. But such an assumption does not always hold true in clinical practice, therefore in order to clarify this problem, the circulatory dynamics of the hypertensives over 60 years of age was analyzed by means of Wezler's new method (1949). The hypertensive pattern with Wezler-Boger's E' type ("Elastizitatshochdruck") characterized by the enhanced elastic resistance was observed in 27 among 40 cases. With the age both total peripheral and elastic resistance increase in their magnitude, and the latter is quite remarkable above 60 years old. The mean value of the elastic resistance is estimated about 2000 dyne/cm5 in the middle-aged patients, whereas that of seven decades over 3000. A senile hypertension with high output can not always be meant by "benign," because such a case is not rarely complicated with cardio-renal decompensation, and not able enough to be treated merely by keeping the psychosomati cquiet. In so-called senile hypertension the extent of the increase in both total peripheral resistance and velocity of the pulse wave shows a rough parallelism to the severity of the retinal findings according to Keith-Wagener's classification. Most of Dexter's third type distinguished by the low vascular elasticity belong to Wezler's E' form; the mean value of the elastic resistance is larger in the third type than in the first or the second type, but as to the peripheral vascular resistance such a tendency can not be recognized. In short, among so-called senile hypertension there is. frequently found "arterio sclerotic" hypertension accompanied with the disturbed "Windkesselfunktion," i. e. "Elastizitatshochdruck" haemodynamically. For the present, the improvement of the elevated elastic resistance can hardly be expected even by the use of new hypotensive drugs. However a senile hypertension with relatively low diastolic pressure is, as a rule, of good prognosis in respect to the cardio-renal compensation except for the cerebral vascular accident. Above described data were further investigated statistically. E' form accompanied with relative diastolic hypotension can be observed only in the cases which show the output within normal range, and either up- or downward from this range there develops a tendency to to difficult to find the diastolic hypotension. Moreover in the group with high output E' tends to decrease while in the group with low output E' tends to increase. 1) In the group with slightly enhanced total peripheral vascular resistance, i. e. W (<1900), E' exists between 1000〜3000 dyne/cm^5. Ps is found higher in the cases with increased output. 2) In the group with W<1900, the standard deviation of the diastolic pressure is relatively small even in the groups with different magnitude of the output; in the cases with 5〜7 L/min of the output Pd is estimated at 87.3 ± 9.4, in the cases with 8〜10 L/min of the output Pd 96.2 ± 13.2. 3) In the cases with W ranked between 1900〜2500, the output was estimated within 4〜6 L/min, the elastic resistance within 2000〜4000 dyne/cm^5. 4) In the cases with W about 2500 dyne/cm^5 and Ps>200 mmHg at the, same time, the output was evaluated between 3〜4 L/min, the elastic resistance between 2500〜4500 dyne/cm^5.
- 千葉大学の論文