若・壮・老年性高血圧症における循環力学的数値の変化
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概要
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Our collaborators [Katsuro, Jinboh and Inagaki (1956 & 1957)] have already reported serially the hemodynamical values of essential hypertension with special reference to the age groups. Thereafter this study in our clinic has been continuously carried on and in the last autumn the number of the observation came up to 296 cases, juvenile, middle-aged and senile. From the comparative investigation of these cases the need of some supplements to the previous works in our clinic became pressing, meanwhile Widimsky et al have published the results about cardiac output of essential hypertension by means of the almost same method as ours, i. e. newly improved Wezler's measurement simultaneously controlled by Fick-Cournand's cardiac catheterization. So that in this paper I would like also to criticize Widimsky's study. 1. It differs from the results obtained in middle aged and senile groups that juvenile hypertensives show not only high value of cardiac output, but also wide distribution of it on the average. 2. Each group was divided further every 20 mmHg of systolic and diastolic pressure level, then the cardiac output of these smaller divisions was summed up and averaged. The cases with lower diastolic pressure show the slightly high cardiac output, while the cases with supranormal diastolic pressure the slightly lower value. The smaller division group with normal diastolic pressure but with systolic pressure ranging between 190 and 209 mmHg shows the high cardiac output. 3. Among the juvenile hypertensives, there are many who show tachycardia, so that the relationship between high cardiac output and tachycardia was examined in this group. The juvenile hypertensives with high cardiac output can be classified into two groups, a with normal heart rates, b. with tachycardia (besides them, there exists, of course, the group with normal cardiac output and tachycardia, or that with both in the normal range). In general, a is found more often than b; b is rather only a small part of the observation. In contrast to the juvenile hypertension, among anemia and hyperthyroidism, there can be found most commonly those who show normal cardiac output and tachycardia; this finding differs evidently from that of hypertensive group. In juvenile hypertension those who show normal cardiac output and tachycardia are found only 16.7%, while in middle aged group such patients nearly 25.6 %. Consequently the correlation between high cardiac output and heart rates found in juvenile hypertension can not be merely concluded to be more frequently observed than that in mi leaddged or senile group. Peripheral vascular resistance and diastolic pressure can be demonstrated in juvenile hypertension as follows, namely as a simple equation, Y=43.7x-1522 while the coefficient decreases gradually in its amount, as the advance of the age. It may be some noteworthy that the diastolic elevation observed, in juvenile hypertension tends to be accompanied by the augmentation of the peripheral vascular resistance. The increase in the volume elasticity module seen in juvenile hypertension may be explained into the regidity of vascular walls, not only morphologically but also functionally, juding from the whole findings of the patient. Smithwick and, especially Dexter have emphasized to be possible clinically to estimate the elasticity of the large arteries, to a certain extent, from diastolic and pulse pressure levels, therefore in this paper, the correlationj between. Dexter's classification and volume elasticity module was also investigated.
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