高血圧緊急症 - matsuyama.jrc.or.jp

1 Matsuyama Red Cross Hospital Division of Hypertension and Endocrinology 101 .. 2014 1 10 . Matsuyama Red Cross Hospital , Internal Medicine Division of Hypertension and Endocrinology . 180/120 mmHg .. 180/120 mmHg .. BP 180/100 mmHg .. BP200/110 mmHg 1.. 77 .. 23 .. 120 mmHg 9 . 120 mmHg 77 .. 10 209/102 mmHg 185/98 182/68. 120 mmHg . MRI MRI. 77 . 5 .. 10 . 17 . 180 mmHg 6 .. MRI . 22 . 5. 120 mmHg 77 .. BUN mg/dl ng/ml/h Cr mg/dl ng/dl (eGFR ml/ ) ACTH pg/ml UA mg/dl g/dl Na 129 mEq/l K mEq/l TSH IU/ml Cl 90 mEq/l freeT4 ng/ml Ca mg/dl PTH-INT pg/ml Matsuyama Red Cross Hospital , division of Hypertension and Endocrinology 77 .. 65 1 or CR1 or 1 . 1 . 65 2 or CR2 or 2 . 2 1 . 77 .. MRI . MRI MRI MRI. Posterior reversible encephalopathy syndrome ( ).

2 PRES . reversible cerebral vasoconstriction syndrome (RCVS). MRA( MRA(2 .. PRES PRES . PRES . Ca .. 2.. 29 .. 2 1 . 3 .. 200/120 mmHg .. 29 .. WBC 5250 / g/dl RBC . 262 / l mg/dl ng/ml/h ( ). Hb 120 130. AST mmHg . 39 U/l ng/dl Ht % ALT 25 U/l MCV. Keith-Wagener fl III (< ). LDH 655 U/l ACTH pg/ml MCH . Pg ALP 235 U/l g/dl MCHC . GTP 31 U/l Plt / BUN mg/dl TSH IU/ml . Cr mg/dl freeT4 ng/ml UA mg/dl PTH-INT 144 pg/ml Na 136 mEq/l K mEq/l BNP 160 pg/ml Cl 95 mEq/l Ca mg/dl P mg/dl HbA1c %. 131 mg/dl Matsuyama Red Cross Hospital Internal Medicine 29 . (mmHg). 260 1 .. 10 1 . (2)1 . (5)1 . 200 ( )1 .. 100. 1 2 3 4 4 .. , . , . , , , , , , , .. 120mmHg , . , , . , , , . , , . , , , . , . , , . , , . , .. , . , , , ,LDH,CPK . , X , . , , CT, MRI, CT.))

3 , , , *,BNP . * .. CBC .. ( CT). ( ( .. 1 or CR or 2 or 2 .. , , , . 5-10 15-30 . g/kg/ . , , .. 5 30 . 5-15 g/kg/ .. , , , .. 2-5 5-10 , . 5-100 g/ .. , , , .. 1-2 . g/kg/ .. , , , . 10-20 3-6 , . 10-20mg .. 1-10mg , . 1-2 3-10 , .. , , 2-10mg 1mg/ .. 2-4mg/4-6 . , .. (Hypertension. 2013;61:1309-1315.). Hypertensive Subjects Age > 70. Intensive BP lowering for 12 weeks(Target BP < 130/80 mmHg). Usual BP lowering for 12 weeka(Target BP <140/85 mmHg). 120 50. 100. Whole gray matter CBF. 30. 80 Changes in CBF. R2= 60 10. 40. -10. 20. 20. pre post pre post -30. 0 -70 -50 -30 -10 10 30. Usual group Intensive group Changes in systolic BP. (Hypertension. 2013;61:1309-1315.). Schematic diagram of the autoregulatory curve shift Hypertension Intensive treated HT.))

4 cerebral blood flow 130 1 0 150. Blood Pressure (Hypertension. 2013;61:1309-1315.). Schematic diagram of the autoregulatory curve shift Normal subjects Patient with acute stroke cerebral blood flow 150 mmHg Blood Pressure JSH2009; . Osaki Y, et al. Poststroke hypertension correlates with neurologic recovery in patients with acute ischemic stroke. Hypertens Res 1998;21:169.. Randomized Control Trial a spontaneous intracerebral hemorrhage Intensive BP lowering (Target BP < 140mmHg for 1 hour). Guideline-recommended treatment (Target BP <180 mmHg). primary outcome death or severe disability Functional outcomes modified rankin scores Yes Yes .. Yes ? ? Yes . 3.. 25 .. MRI. CT. 24 .. MRI MRI MRA.. 120 mmHg 160mg 20mg BP>150 mmHg 40mg 8 .. Matsuyama Red Cross Hospital Division of Hypertension and Endocrinology 101.

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