{"id":1951,"date":"2020-08-20T11:18:09","date_gmt":"2020-08-20T02:18:09","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=1951"},"modified":"2020-08-20T11:18:09","modified_gmt":"2020-08-20T02:18:09","slug":"%e5%ad%a4%e7%ab%8b%e6%80%a7%e6%8b%a1%e5%bc%b5%e6%9c%9f%e9%ab%98%e8%a1%80%e5%9c%a7%e3%81%a8%e5%bf%83%e8%a1%80%e7%ae%a1%e3%83%aa%e3%82%b9%e3%82%af%ef%bc%882020%e5%b9%b41%e6%9c%88%ef%bc%89","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=1951","title":{"rendered":"\u5b64\u7acb\u6027\u62e1\u5f35\u671f\u9ad8\u8840\u5727\u3068\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\uff082020\u5e741\u6708\uff09"},"content":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059\u3002<\/p>\n

\uff1d\u6587\u732e\u540d\uff1d
\nMcEvoy JW, Daya N, Rahman F, Hoogeveen RC, Blumenthal RS, Shah AM, Ballantyne CM, Coresh J, Selvin E. Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC\/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes. JAMA. 2020;323(4):329.<\/p>\n

\uff1d\u8981\u7d04\uff1d
\nIntroduction<\/strong>
\n\u9ad8\u8840\u5727\u306f\u3001\u53ce\u7e2e\u671f\u8840\u5727\u306e\u4e0a\u6607\u3001\u62e1\u5f35\u671f\u8840\u5727\u306e\u4e0a\u6607\u3001\u307e\u305f\u306f\u305d\u306e\u4e21\u65b9\u306b\u57fa\u3065\u3044\u3066\u8a3a\u65ad\u3067\u304d\u308b\u3002American College of Cardiology\uff08ACC\uff09\/ American Heart Association\uff08AHA\uff09\u306b\u3088\u3063\u3066\u767a\u884c\u3055\u308c\u305f2017 \u9ad8\u8840\u5727\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306f\u5b9a\u7fa9\u3092\u5909\u66f4\u3057\u305f\u3002140\/90 mmHg\u4ee5\u4e0a\u306e\u30ab\u30c3\u30c8\u30aa\u30d5\uff08\u3059\u306a\u308f\u3061JNC7\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306b\u3088\u308b\u4ee5\u524d\u306e2003\u5e74\u306e\u95be\u5024\uff09\u304b\u3089130\/80 mmHg\u4ee5\u4e0a\u306e\u4e0b\u9650\u95be\u5024\u3078\u306e\u8840\u5727\u306e\u4e0a\u6607\u306b\u5909\u66f4\u3068\u306a\u3063\u305f\u3002\u9ad8\u8840\u5727\u306e\u62e1\u5f35\u671f\u8840\u5727\u306e\u95be\u5024\u309290 mmHg\u304b\u308980 mmHg\u306b\u4e0b\u3052\u308b\u3068\u3044\u3046\u63a8\u5968\u306f\u3001\u8a66\u9a13\u30c7\u30fc\u30bf\u3067\u306f\u306a\u304f\u5c02\u9580\u5bb6\u306e\u610f\u898b\u306b\u57fa\u3065\u3044\u3066\u3044\u308b\u3002\u3053\u306e\u5909\u66f4\u306f\u3001\u65b0\u3057\u3044\u57fa\u6e96\uff08ACC \/ AHA 2017\uff09\u306b\u3088\u308b\u62e1\u5f35\u671f\u8840\u5727\u304c130 mmHg\u672a\u6e80\u3067\u3001\u62e1\u5f35\u671f\u8840\u5727\u304c80 mmHg\u4ee5\u4e0a\u3067\u3042\u308b\u3001\u5b64\u7acb\u6027\u62e1\u5f35\u671f\u9ad8\u8840\u5727\uff08IDH\uff09\u3068\u547c\u3070\u308c\u308b\u5b58\u5728\u306b\u5927\u304d\u306a\u5f71\u97ff\u3092\u4e0e\u3048\u308b\u3002\u3057\u304b\u3057\u3001JNC7\u57fa\u6e96\u306b\u3088\u308b\u3068\u3001\u53ce\u7e2e\u671f\u8840\u5727\u304c140 mmHg\u672a\u6e80\u3067\u62e1\u5f35\u671f\u8840\u5727\u304c90 mmHg\u4ee5\u4e0a\u3067\u3042\u308b\u3002\u4ee5\u524d\u306e\u7814\u7a76\u3067\u306f\u3001IDH\uff08JNC7\u8a3a\u65ad\u57fa\u6e96\u306b\u57fa\u3065\u304f\uff09\u304c\u82e5\u3044\u4eba\u3067\u3088\u308a\u4e00\u822c\u7684\u3067\u3042\u308a\u3001\u5c06\u6765\u306b\u53ce\u7e2e\u671f\u9ad8\u8840\u5727\u306b\u95a2\u9023\u3057\u3066\u3044\u308b\u3053\u3068\u304c\u793a\u5506\u3055\u308c\u3066\u3044\u308b\u3002\u305f\u3060\u3057\u3001\u4e00\u822c\u7684\u306b\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306e\u53ce\u7e2e\u671f\u8840\u5727\u3068\u72ec\u7acb\u3057\u3066\u30a2\u30c6\u30ed\u30fc\u30e0\u6027\u52d5\u8108\u786c\u5316\u75c7\uff08ASCVD\uff09\u306e\u7d50\u679c\u3068\u306f\u95a2\u9023\u3057\u306a\u3044\u3068\u3055\u308c\u3066\u3044\u308b\u3002
\n\u3053\u306e\u7814\u7a76\u306b\u306f2\u3064\u306e\u76ee\u7684\u304c\u3042\u308b\u3002\uff081\uff09JNC7\u304a\u3088\u30732017\u5e74\u307e\u3067\u306b\u7c73\u56fd\u6210\u4eba\u96c6\u56e3\u306b\u304a\u3051\u308bIDH\u306e\u6709\u75c5\u7387\u3092\u63a8\u5b9a\u3059\u308b\u3053\u3068\u3002\uff082\uff09\u4e21\u65b9\u306eIDH\u5b9a\u7fa9\u3068ASCVD\u3001\u5fc3\u4e0d\u5168\uff08HF\uff09\u3001\u6162\u6027\u814e\u81d3\u75c5\uff08CKD\uff09\u3068\u306e\u95a2\u9023\u3092\u8a55\u4fa1\u3059\u308b\u3053\u3068\u3067\u3042\u308b\u3002<\/p>\n

Objective<\/strong>
\n\u7c73\u56fd\u306b\u304a\u3051\u308b\u5b64\u7acb\u6027\u62e1\u5f35\u671f\u9ad8\u8840\u5727\uff08IDH\uff09\u306e\u6709\u75c5\u7387\u30922017\u5e74\u306eACC \/ AHA\u304a\u3088\u30732003\u5e74\u306e\u5408\u540c\u5168\u56fd\u59d4\u54e1\u4f1a\uff08JNC7\uff09\u306e\u5b9a\u7fa9\u3067\u6bd4\u8f03\u3057\u3001IDH\u3068\u7d50\u679c\u3068\u306e\u6a2a\u65ad\u7684\u304a\u3088\u3073\u9577\u671f\u7684\u306a\u95a2\u9023\u3092\u7279\u5fb4\u4ed8\u3051\u308b\u3053\u3068\u3002<\/p>\n

Methods<\/strong>
\n\u5168\u56fd\u5065\u5eb7\u304a\u3088\u3073\u6804\u990a\u691c\u67fb\u8abf\u67fb\uff08NHANES 2013-2016\uff09\u306e\u6a2a\u65ad\u7684\u5206\u6790\u3068\u3001\u5730\u57df\u793e\u4f1a\u306e\u30a2\u30c6\u30ed\u30fc\u30e0\u6027\u52d5\u8108\u786c\u5316\u75c7\u30ea\u30b9\u30af\uff08ARIC\uff09\u306e\u7e26\u65ad\u7684\u5206\u6790\uff081990-1992\u3092\u57fa\u6e96\u306b2017\u5e7412\u670831\u65e5\u307e\u3067\u306e\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\uff09\u3067\u884c\u3044\u3001\u7e26\u65ad\u7684\u7d50\u679c\u306f\u30012\u3064\u306e\u5916\u90e8\u30b3\u30db\u30fc\u30c8\u3067\u691c\u8a3c\u3055\u308c\u307e\u3057\u305f\u3002
\nARIC\u7814\u7a76\u306b\u304a\u3051\u308b\u30a2\u30c6\u30ed\u30fc\u30e0\u6027\u52d5\u8108\u786c\u5316\u6027\u5fc3\u8840\u7ba1\u75be\u60a3\uff08ASCVD\uff09\u3001\u5fc3\u4e0d\u5168\uff08HF\uff09\u3001\u6162\u6027\u814e\u75be\u60a3\uff08CKD\uff09\u306e\u30ea\u30b9\u30af\u3092\u4e3b\u8981\u30a2\u30a6\u30c8\u30ab\u30e0\u3068\u3057\u3066\u6e2c\u5b9a\u3057\u305f\u3002<\/p>\n

Results<\/strong>
\n\u7814\u7a76\u5bfe\u8c61\u96c6\u56e3\u306b\u306f\u3001NHANES\u306e9,590\u4eba\u306e\u6210\u4eba\uff08\u5e73\u5747[SD]\u57fa\u6e96\u5e74\u9f62\u300149.6 [17.6]\u6b73; 5016\u4eba\u306e\u5973\u6027[52.3\uff05]\uff09\u3068ARIC\u7814\u7a76\u306e8,703\u4eba\u306e\u6210\u4eba\uff08\u5e73\u5747[SD]\u57fa\u6e96\u5e74\u9f62\u300156.0 [5.6]\u6b73\uff09\u304c\u542b\u307e\u308c\u3066\u3044\u305f; 4,977\u4eba\u306e\u5973\u6027[57.2\uff05]\uff09\u3002NHANES\u306b\u304a\u3051\u308bIDH\u306e\u63a8\u5b9a\u6709\u75c5\u7387\u306f\u30012017 ACC \/ AHA\u306e\u5b9a\u7fa9\u3067\u306f6.5\uff05\u3001JNC7\u306e\u5b9a\u7fa9\u3067\u306f1.3\uff05\u3060\u3063\u305f\uff08\u7d76\u5bfe\u5dee\u30015.2\uff05[95\uff05CI\u30014.7\uff05-5.7\uff05]\uff09\u3002IDH\u304c\u3042\u308b\u3068\u65b0\u305f\u306b\u5206\u985e\u3055\u308c\u305f\u60a3\u8005\u306e\u3046\u3061\u3001\u63a8\u5b9a0.6\uff05\uff0895\uff05CI\u30010.5\uff05-0.6\uff05\uff09\u3082\u964d\u5727\u7642\u6cd5\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u95be\u5024\u3092\u6e80\u305f\u3057\u305f\u3002\u6b63\u5e38\u8840\u5727\u306eARIC\u53c2\u52a0\u8005\u3068\u6bd4\u8f03\u3057\u3066\u30012017 ACC \/ AHA\u5b9a\u7fa9\u306b\u3088\u308bIDH\u306fASCVD\u3068\u6709\u610f\u306b\u95a2\u9023\u3057\u3066\u3044\u306a\u304b\u3063\u305f\uff08n = 1386\u30a4\u30d9\u30f3\u30c8\u3001\u8ffd\u8de1\u671f\u9593\u4e2d\u592e\u502425.2\u5e74\u3001\u30cf\u30b6\u30fc\u30c9\u6bd4[HR] 1.06 [95\uff05CI\u30010.89-1.26 ]\uff09\u3001HF\uff08n = 1396\u30a4\u30d9\u30f3\u30c8; HR 0.91 [95\uff05CI\u30010.76-1.09]\uff09\u3001CKD\uff08n = 2433\u30a4\u30d9\u30f3\u30c8; HR 0.98 [95\uff05CI\u30010.65-1.11]\uff09\u3002\u307e\u305f\u30012\u3064\u306e\u5916\u90e8\u30b3\u30db\u30fc\u30c8\u306b\u304a\u3051\u308b\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u306e\u7d50\u679c\u3082\u7121\u52b9\u3060\u3063\u305f\u3002\uff082017 ACC \/ AHA\u5b9a\u7fa9\u306b\u3088\u308bIDH\u306eHR\u306f\u30011.17 [95\uff05CI\u30010.87-1.56]\u3001NHANES[n = 1012\u30a4\u30d9\u30f3\u30c8]\u3067\u306f\u30011.02 [95\uff05CI\u30010.92-1.14]\u3001CLUE\u2161\u306f[n = 1497\u30a4\u30d9\u30f3\u30c8]\u3060\u3063\u305f\u3002<\/p>\n

\"JC\u5800\u3066202007\u2461\"<\/a><\/p>\n

\"JC\u5800\u3066202007\u2460\"<\/a><\/p>\n

Discussion<\/strong>
\n\u4eca\u56de\u306e\u8ad6\u6587\u3067\u306f\u30015\u3064\u306e\u9650\u754c\u304c\u63d0\u793a\u3055\u308c\u3066\u3044\u308b\u3002\u7b2c1\u306f\u3001\u305d\u306e\u5f8c\u306e\u964d\u5727\u85ac\u306e\u4f7f\u7528\u3084\u53ce\u7e2e\u8840\u5727\u30ec\u30d9\u30eb\u306e\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u306a\u3069\u306b\u3088\u308b\u4ea4\u7d61\u3092\u6392\u9664\u3059\u308b\u3053\u3068\u304c\u3067\u304d\u306a\u3044\u3053\u3068\u3067\u3042\u308b\u3002\u7b2c2\u306f\u3001\u53c2\u52a0\u8005\u306e\u6700\u4f4e\u5e74\u9f62\u304c48\u6b73\u3060\u3063\u305f\u305f\u3081\u3001\u4eca\u56de\u306e\u7d50\u679c\u304c\u82e5\u3044\u4eba\u306b\u4e00\u822c\u5316\u3067\u304d\u306a\u3044\u53ef\u80fd\u6027\u304c\u3042\u308b\u70b9\u3067\u3042\u308b\u3002\u7b2c3\u306f\u3001\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306e\u9ad8\u8840\u5727\u306e\u76ee\u6a19\u304c\u6cbb\u7642\u3057\u3066\u3044\u308b\u4eba\u3068\u3001\u6cbb\u7642\u3092\u53d7\u3051\u3066\u3044\u306a\u3044\u4eba\u306e\u4e21\u65b9\u306b\u9069\u7528\u3055\u308c\u308b\u305f\u3081\u3001\u964d\u5727\u85ac\u3092\u4f7f\u7528\u3057\u3066\u3044\u308b\u4eba\u304c\u4e00\u6b21\u5206\u6790\u306b\u542b\u307e\u308c\u3066\u3044\u305f\u3053\u3068\u3067\u3042\u308b\u3002\u3057\u304b\u3057\u3001\u5c64\u5225\u89e3\u6790\u3067\u306f\u3001\u964d\u5727\u85ac\u3092\u670d\u7528\u3057\u3066\u3044\u306a\u3044\u53c2\u52a0\u8005\u306e\u9593\u3067\u7d50\u679c\u306f\u540c\u7b49\u3060\u3063\u305f\u3002\u7b2c4\u3068\u3057\u3066\u306f\u3001ARIC\u7814\u7a76\u306e\u7d50\u679c\u81ea\u4f53\u306f\u3001\u767d\u4eba\u3001\u9ed2\u4eba\u3068\u3057\u3066\u8b58\u5225\u3055\u308c\u306a\u3044\u4eba\u306b\u306f\u9069\u7528\u3055\u308c\u306a\u3044\u304c\u3001\u4eca\u56de\u306e\u8abf\u67fb\u7d50\u679c\u306f\u3001\u5168\u56fd\u7684\u306b\u4eba\u7a2e\u3092\u4ee3\u8868\u3059\u308b\u3088\u3046\u306b\u8a2d\u8a08\u3055\u308c\u3066\u3044\u308b\u3002\u7b2c5\u306f\u3001\u3053\u306e\u5206\u6790\u7d50\u679c\u306f\u3001IDH\u3068\u6709\u5bb3\u30a4\u30d9\u30f3\u30c8\u9593\u306e\u3088\u308a\u7de9\u3084\u304b\u306a\u95a2\u9023\u4ed8\u3051\u3092\u691c\u51fa\u3059\u308b\u305f\u3081\u306b\u6d3b\u7528\u3055\u308c\u3066\u3044\u306a\u3044\u53ef\u80fd\u6027\u304c\u3042\u308b\u3002\u305f\u3060\u3057\u3001\u5fc3\u8840\u7ba1\u6b7b\u4ea1\u7387\u306e\u95a2\u9023\u6027\u306f\u30012\u3064\u306e\u5916\u90e8\u691c\u8a3c\u30b3\u30db\u30fc\u30c8\u306e\u7d045\u4e07\u4eba\u306e\u53c2\u52a0\u8005\u3067\u985e\u4f3c\u3057\u3066\u3044\u305f\u3002<\/p>\n

Conclusion<\/strong>
\n\u3053\u306e\u7c73\u56fd\u306e\u6210\u4eba\u306e\u5206\u6790\u3067\u306f\u3001IDH\u306e\u63a8\u5b9a\u6709\u75c5\u7387\u306f\u3001JNC7\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3068\u6bd4\u8f03\u3057\u3066\u30012017 ACC \/ AHA \u9ad8\u8840\u5727\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306b\u3088\u3063\u3066\u5b9a\u7fa9\u3055\u308c\u305f\u5834\u5408\u3067\u3088\u308a\u4e00\u822c\u7684\u3060\u3063\u305f\u3002\u305f\u3060\u3057\u3001IDH\u306f\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u30ea\u30b9\u30af\u5897\u52a0\u3068\u6709\u610f\u306b\u95a2\u9023\u3057\u3066\u3044\u306a\u304b\u3063\u305f\u3002<\/p>\n

\u3010\u958b\u50ac\u65e5\u30112020\u5e747\u670822\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\u203b\u3053\u306e\u6642\u671f\u306eUpToDate\u306b\u3042\u308b\u201dWhat\u2019s new in family medicine\u201d\u306eTopic\u3067\u53c2\u8003\u306b\u3055\u308c\u3066\u3044\u308b\u6587\u732e\u3067\u3059\u3002 \uff1d\u6587\u732e\u540d\uff1d McEvoy JW, Daya N, Rahman F, Hoogev … \u7d9a\u304d\u3092\u8aad\u3080 \u5b64\u7acb\u6027\u62e1\u5f35\u671f\u9ad8\u8840\u5727\u3068\u5fc3\u8840\u7ba1\u30ea\u30b9\u30af\uff082020\u5e741\u6708\uff09<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33,17],"tags":[],"class_list":["post-1951","post","type-post","status-publish","format-standard","hentry","category-whats-new","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1951","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1951"}],"version-history":[{"count":4,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1951\/revisions"}],"predecessor-version":[{"id":1957,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1951\/revisions\/1957"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1951"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1951"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1951"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}