老年性縮期圧性(動脈硬化性)高血圧症の循環動態からみた降圧剤の薬効分柝(ことにRauwolfia Serpentinaについて)
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Of 64 hypertensive patients treated with Rauwolfia serpentina there were observed 66% whose blood pressures were decreased by 20 mmHg in systolic and by 15 mmHg in diastolic; 38% whose dynamical mean pressures were lowered by 20 mmHg; 30% whose systolic and diastolic pressures were reduced to normal range (150/90mmHg). Of 15 cases medicated with R. s. above 60 years old there were ascertained 67, 40, 7% and of 46 patients administered with R. s. under 59 years old 65, 37, 35% correspondently.It is possibly due to the high incidence of systolic hypertension in advanced aging group that both systolic and diasnolic pressure were reduced at large percentage in cases above 60 years old. In order to further elucidate this point, the elasticity moduli were calculated by means of Dexter's formula, and following results were obtained. Of 15 patients there were observed 14 cases (93%) with diminished elasticity moduli, and 87% after the medication with Rauwolfia. This suggests that the majority of patients above 60 years old observed here is sure to be arteriosclerotic (systolic) hypertensive cases, whereas of total 65 patients there were 52 cases (80%) with elastivity hypertension in the sense of Dexter. Circulatory dynamics were analysed by means of Wezler-Böger's method in 19 cases with hypertension above 60 years old of which 13 patients (69%) showed larger E' than normal range. Dexter's classification agrees with that of Wezler-Böger's in 14 cases of 19, therefore it appears that Dexter's classification is of considerable clinical value.The above mentioned can be summerized as follows:-1. Pros & Cons upon the medication with Rauwolfia serpentina in the hypertensive patients of aged above 60 years old are discussed from the hemodynamic analytical standpoints.2. In the hypertensive cases of aged it is sometimes difficult to estimate the hemod-ynsmics by means of Wezler-Böger's method. In such a case, taking care to avoid danger, we are compelled to make shift with Fick-Cournand's method.3. The percentage of hypertensive potency of Rauwolfia is proved larger in the senil group than in the young.4. The vascular elasticity calculated from Dexter's formula roughly agrees with volume elasticity and elasticity modulus obtained from Wezler Böger's method5. The hypertensive cases of aged are frequently subject to the senil arteriosclerotic high blood pressure. Classifying them according to Wezler Böger's interpretation, most of them can be placed under the category of W+E', M+E' or M+E'+W type. While the circulatory dynamics of M+E' type can be scarcely improved by administration with Rauwolfia, W+E' type can be ameliorated fairly well. In the M form the treatment by the use of Rauwolfia is very often superflous (Authors' Referate).
- 社団法人 日本内科学会の論文