本態性高血圧における年齢とCa拮抗薬の有用性

Diazem二重盲検試験の検討

抄録

The antihypertensive effect of a calcium entry blocker, diltiazem (Herbesse®), was evaluated in different age groups by using a double-blind group comparison method. In a monotherapy study, 57 patients were divided into a group of 25 younger patients aged less than 59 years (50.4 years on the average) and a group of 32 older patients aged more than 60 years (66.3 years on the average). In a study of combined therapy with diuretics, 119 patients were divided into three groups ; 40 younger patients in their thirties and forties (average age 41. 7 years), 45 middle-aged patients in their fifties (average age 54. 3 years) and 34 older patients aged more than 60 years (average age 64. 1 years). Diltiazem 90 to 180 mg per day was used for 12 weeks in both studies.
Antihypertensive effects (blood pressure falling 20/10 mmHg or more) were ob served in 83.3 % of the younger patients and 66.7% of the older patients in monotherapy, showing significant difference (P<0.05). In combined therapy, antihypertensive effects were observed in 81.1% of the younger patients, in 76. 3% of the middle-aged patients, and in 71. 9% of the older patients, showing no significant ifference in each age group.Blood pressure decreased from 176. 3/102. 7 mmHg to 149.1/85.0 mmHg in the younger patients, and from 174.8/97.7 mmHg to 157. 7/86.2 mmHg in the older patients on monotherapy. In the combined therapy, blood pressure decreased from 169.8/108.5 mmHg to 145.2/93. 4 mmHg in the younger patients, from 173.3/102.5 mmHg to 147.4/89.1 mmHg in the middle-aged patients, and from 175.4/101.5 mmHg to 149.7/88.9 mmHg in the older patients. The decrease in blood pressure was not significantly different in each age group.Heart rate was lowered slightly in the younger patients, but did not change in the older patients in either monotherapy or combined therapy.
The incidence of side effects was 12.0% in the younger patients and 15. 6% in the older patients on monotherapy, while the incidence for combined therapy was 14.0% in the younger patients, 10.9% in the middle-aged patients and 11.0% in the older patients. Laboratory data revealed no significant changes in either monotherapy or combined therapy in each age group.
The results indicated that the Ca entry blocker, diltiazem, has usefulness (useful or above) at 80. 0% in the younger patients and 76.3% in the older patients on monotherapy, while the rates for combined therapy were 81.1% in the younger patients, 76.3% in the middle-aged patients, and 71.9% in the older patients. There was also no significant difference between age groups in either therapy. The Ca entry blocker, diltiazem, seemed to be equally useful for the treatment of both older and younger patients with essential hypertension.