{"id":1962,"date":"2020-08-27T08:46:42","date_gmt":"2020-08-26T23:46:42","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=1962"},"modified":"2020-08-27T08:46:42","modified_gmt":"2020-08-26T23:46:42","slug":"%e9%ab%98%e9%bd%a2%e8%80%85%e3%81%ae%e9%99%8d%e5%9c%a7%e5%89%a4%e3%81%ae%e6%b8%9b%e8%96%ac%e3%81%ab%e3%81%a4%e3%81%84%e3%81%a6","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=1962","title":{"rendered":"\u9ad8\u9f62\u8005\u306e\u964d\u5727\u5264\u306e\u6e1b\u85ac\u306b\u3064\u3044\u3066"},"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

\uff0d\u6587\u732e\u540d\uff0d
\nJames P. Sheppard, et al. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older. JAMA. 2020;323(20):2039.<\/p>\n

\uff0d\u8981\u7d04\uff0d
\nIntroduction
\n\u9ad8\u8840\u5727\u75c7\u306f\u5fc3\u8840\u7ba1\u75be\u60a3\u306e\u5371\u967a\u56e0\u5b50\u306e\u7b2c\u4e00\u4f4d\u3067\u3042\u308a\u3001\u591a\u81d3\u5668\u5408\u4f75\u75c7\u306e\u9ad8\u9f62\u8005\u3067\u306f\u6700\u3082\u4e00\u822c\u7684\u306a\u4f75\u5b58\u75be\u60a3\u3067\u3042\u308b\u3002\u964d\u5727\u5264\u306b\u3088\u308b\u6cbb\u7642\u306f\u8133\u5352\u4e2d\u3084\u5fc3\u8840\u7ba1\u75be\u60a3\u3092\u4e88\u9632\u3057\u300180\u6b73\u4ee5\u4e0a\u306e\u60a3\u8005\u306e\u7d04\u534a\u6570\u304c\u964d\u5727\u5264\u3092\u51e6\u65b9\u3055\u308c\u3066\u3044\u308b\u3002\u3057\u304b\u3057\u3001\u904e\u53bb\u306e\u89b3\u5bdf\u7814\u7a76\u3067\u306f\u3001\u8907\u6570\u306e\u964d\u5727\u5264\u51e6\u65b9\u306b\u3088\u308b\u8840\u5727\u4f4e\u4e0b\u304c\u8907\u6570\u306e\u75be\u75c5\u3092\u6709\u3059\u308b\u4e00\u90e8\u306e\u9ad8\u9f62\u8005\u306b\u304a\u3044\u3066\u6709\u5bb3\u3067\u3042\u308b\u53ef\u80fd\u6027\u3092\u793a\u5506\u3057\u3066\u3044\u308b\u3002
\n\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3067\u306f\u3001\u865a\u5f31\u9ad8\u9f62\u60a3\u8005\u306b\u964d\u5727\u5264\u3092\u51e6\u65b9\u3059\u308b\u969b\u306b\u306f\u500b\u5225\u306e\u81e8\u5e8a\u7684\u5224\u65ad\u3092\u884c\u3046\u3053\u3068\u304c\u63a8\u5968\u3055\u308c\u3066\u3044\u308b\u304c\u3001\u3053\u308c\u3089\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306f\u6e1b\u85ac\u3078\u306e\u624b\u9806\u306f\u66d6\u6627\u3067\u3042\u308a\u3001\u30a8\u30d3\u30c7\u30f3\u30b9\u81ea\u4f53\u304c\u4e0d\u8db3\u3057\u3066\u3044\u308b\u305f\u3081\u3001\u3053\u306e\u5206\u91ce\u3067\u306e\u7814\u7a76\u306e\u5fc5\u8981\u6027\u304c\u5f37\u8abf\u3055\u308c\u3066\u3044\u305f\u3002
\n\u3053\u306e\u8a66\u9a13\u3067\u306f\u30012\u7a2e\u985e\u4ee5\u4e0a\u306e\u964d\u5727\u5264\u3092\u51e6\u65b9\u3055\u308c\u3066\u3044\u308b\u8907\u6570\u306e\u75be\u75c5\u3092\u6709\u3057\u3001\u53ce\u7e2e\u671f\u8840\u5727\u7ba1\u7406\u304c\u826f\u597d\u306a\u9ad8\u8840\u5727\u75c7\u306e\u9ad8\u9f62\u8005\u3092\u5bfe\u8c61\u306b\u3001\u964d\u5727\u5264\u306e\u6e1b\u91cf\u306b\u5bfe\u3059\u308b\u69cb\u9020\u5316\u3055\u308c\u305f\u30a2\u30d7\u30ed\u30fc\u30c1\u3092\u5b9f\u65bd\u3057\u305f\u3002\u3053\u306e\u8a66\u9a13\u306f\u300112\u9031\u9593\u306e\u8ffd\u8de1\u8abf\u67fb\u3067\u81e8\u5e8a\u7684\u306a\u5909\u5316\uff08\u8840\u5727\u7ba1\u7406\u4e0d\u826f\u3001\u865a\u5f31\u6027\u3001QOL\u3001\u526f\u4f5c\u7528\u3001\u91cd\u7be4\u306a\u6709\u5bb3\u4e8b\u8c61\uff09\u306a\u3057\u306b\u3001\u90e8\u5206\u7684\u306b\u3067\u3082\u964d\u5727\u5264\u306e\u6e1b\u85ac\u304c\u53ef\u80fd\u3067\u3042\u308b\u304b\u3069\u3046\u304b\u3092\u691c\u8a3c\u3059\u308b\u3053\u3068\u304c\u76ee\u7684\u306e\u7814\u7a76\u3067\u3042\u308b\u3002<\/p>\n

Method
\n\u672c\u7814\u7a76\u306f\u30a4\u30f3\u30b0\u30e9\u30f3\u30c9\u5357\u90e8\u3068\u4e2d\u90e8\u306e\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u65bd\u8a2d\u3067\u5b9f\u65bd\u3055\u308c\u305f\u3082\u306e\u3067\u3042\u308b\u3002\u5bfe\u8c61\u3068\u306a\u308b\u53c2\u52a0\u8005\u306f80\u6b73\u4ee5\u4e0a\u3067\u3001\u30d9\u30fc\u30b9\u30e9\u30a4\u30f3\u306e\u53ce\u7e2e\u671f\u8840\u5727\u304c150mmHg\u672a\u6e80\u3067\u30012\u3064\u4ee5\u4e0a\u306e\u964d\u5727\u5264\u309212\u30f6\u6708\u4ee5\u4e0a\u51e6\u65b9\u3055\u308c\u3066\u3044\u308b\u65b9\u3067\u3042\u308b\u3002\u5bfe\u8c61\u8005\u306e\u52df\u96c6\u3092\u884c\u3063\u305f\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u533b\u306b\u306f\u3001\u6700\u65b0\u306e\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u3084\u30a8\u30d3\u30c7\u30f3\u30b9\u306b\u3064\u3044\u3066\u306e\u5b66\u7fd2\u3092\u4e8b\u524d\u306b\u5b9f\u65bd\u3057\u305f\u3002\u53c2\u52a0\u8005\u306f\u30dd\u30ea\u30d5\u30a1\u30fc\u30de\u30b7\u30fc\u3001\u4f75\u5b58\u75be\u60a3\u3001\u85ac\u306e\u30a2\u30c9\u30d2\u30a2\u30e9\u30f3\u30b9\u304c\u60aa\u3044\u3001\u865a\u5f31\u4f53\u8cea\u306a\u3069\u306e\u7279\u5fb4\u304c\u4e00\u3064\u4ee5\u4e0a\u3042\u308a\u3001\u6295\u85ac\u306e\u4e2d\u6b62\u3067\u6069\u6075\u3092\u53d7\u3051\u308b\u53ef\u80fd\u6027\u304c\u9ad8\u3044\u60a3\u8005\u306e\u307f\u304c\u7814\u7a76\u306b\u767b\u9332\u3055\u308c\u305f\u3002\u904e\u53bb12\u30f5\u6708\u9593\u306b\u5de6\u5ba4\u6a5f\u80fd\u969c\u5bb3\u306b\u3088\u308b\u5fc3\u4e0d\u5168\u3001\u5fc3\u7b4b\u6897\u585e\u307e\u305f\u306f\u8133\u5352\u4e2d\u306e\u65e2\u5f80\u6b74\u306e\u3042\u308b\u60a3\u8005\u3001\u4e8c\u6b21\u6027\u9ad8\u8840\u5727\u3001\u307e\u305f\u540c\u610f\u80fd\u529b\u306e\u306a\u3044\u60a3\u8005\u306f\u7814\u7a76\u304b\u3089\u9664\u5916\u3055\u308c\u305f\u3002
\n\u53c2\u52a0\u8005\u306f\u3001\u964d\u5727\u5264\u306e\u6e1b\u85ac\uff08\u4ecb\u5165\u7fa4\uff09\u3068\u901a\u5e38\u306e\u30b1\u30a2\uff08\u5bfe\u7167\u7fa4\uff09\u306b\u7121\u4f5c\u70ba\u306b\u5272\u308a\u4ed8\u3051\u3089\u308c\u3001\u7814\u7a76\u8005\u3068\u53c2\u52a0\u8005\u3078\u96a0\u853d\u5316\u3055\u308c\u305f\u3002\u975e\u76f2\u691c\u5316\u306e\u30c7\u30b6\u30a4\u30f3\u3092\u3068\u3063\u3066\u304a\u308a\u3001\u4e8b\u524d\u306b\u5b9a\u3081\u3089\u308c\u305f\u7d71\u8a08\u89e3\u6790\u306f\u3001\u53c2\u52a0\u8005\u306e\u5272\u308a\u4ed8\u3051\u3068\u306f\u7121\u95a2\u4fc2\u306b\u5b9f\u65bd\u3055\u308c\u305f\u3002
\n\u4ecb\u5165\u7fa4\u306e\u6e1b\u85ac\u5f8c\u306f\u3001\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u533b\u306b\u3088\u308a4\u9031\u9593\u5f8c\u306e\u6642\u70b9\u3067\u8a55\u4fa1\u3055\u308c\u3001\u53ce\u7e2e\u671f\u8840\u5727\u304c150mmHg\u4ee5\u4e0a\u3001\u307e\u305f\u306f\u62e1\u5f35\u671f\u8840\u5727\u304c90mmHg\u4ee5\u4e0a\u306e\u72b6\u614b\u304c1\u9031\u9593\u4ee5\u4e0a\u7d9a\u3044\u305f\u5834\u5408\u3001\u6709\u5bb3\u4e8b\u8c61\u304c\u767a\u751f\u3057\u305f\u5834\u5408\u3001\u307e\u305f\u306f\u8840\u5727\u4e0a\u6607\u306e\u5146\u5019\u304c\u898b\u3089\u308c\u305f\u5834\u5408\u306b\u306f\u3001\u964d\u5727\u5264\u306e\u6cbb\u7642\u518d\u958b\u3092\u884c\u3063\u305f\u3002\u5bfe\u7167\u7fa4\u306b\u7121\u4f5c\u70ba\u306b\u5272\u308a\u4ed8\u3051\u3089\u308c\u305f\u53c2\u52a0\u8005\u306f\u3001\u51e6\u65b9\u3055\u308c\u305f\u901a\u308a\u306b\u3059\u3079\u3066\u306e\u964d\u5727\u5264\u3092\u670d\u7528\u3057\u3001\u85ac\u306e\u5909\u66f4\u3092\u5f37\u5236\u3055\u308c\u308b\u3053\u3068\u306a\u304f\u3001\u901a\u5e38\u306e\u81e8\u5e8a\u30b1\u30a2\u306b\u5f93\u3044\u3001\u3059\u3079\u3066\u306e\u60a3\u8005\u306f12\u9031\u9593\u306e\u6642\u70b9\u3067\u30d5\u30a9\u30ed\u30fc\u30a2\u30c3\u30d7\u3055\u308c\u305f\u3002
\nPrimary outcome\u306f12\u9031\u9593\u306e\u8ffd\u8de1\u8abf\u67fb\u306b\u304a\u3051\u308b\u53ce\u7e2e\u671f\u8840\u5727\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u306e\u7fa4\u9593\u306e\u76f8\u5bfe\u30ea\u30b9\u30af\u3067\u3042\u308b\u3002\u8840\u5727\u6e2c\u5b9a\u306f\u3001\u81e8\u5e8a\u7684\u306b\u691c\u8a3c\u3055\u308c\u305f\u8840\u5727\u8a08\u3092\u7528\u3044\u3066\u6e2c\u5b9a\u3055\u308c\u3001\u6e2c\u5b9a\u5024\u306f\u53c2\u52a0\u8005\u304c\u5c11\u306a\u304f\u3068\u30825\u5206\u9593\u5ea7\u3063\u3066\u5b89\u9759\u306b\u3057\u305f\u5f8c\u3001\u9069\u5207\u306a\u30b5\u30a4\u30ba\u306e\u30ab\u30d5\u3092\u4f7f\u7528\u3057\u3066\u5de6\u8155\u3067\u6e2c\u5b9a\u3055\u308c\u305f\u3002Secondary outcome\u306b\u306f\u3001\u865a\u5f31\u6027\u3001QOL\u3001\u526f\u4f5c\u7528\u3001\u91cd\u7be4\u306a\u6709\u5bb3\u4e8b\u8c61\u3001\u53ce\u7e2e\u671f\u8840\u5727\u3068\u62e1\u5f35\u671f\u8840\u5727\u306e12\u9031\u9593\u306e\u5909\u5316\u306b\u304a\u3051\u308b\u7fa4\u9593\u5dee\u3067\u3042\u3063\u305f\u3002\u865a\u5f31\u6027\u306f\u3001Frailty index\u3001Electronic Frailty Index\u3001\u304a\u3088\u3073Morley FRAIL\u30b9\u30b1\u30fc\u30eb\u3092\u7528\u3044\u3066\u5b9a\u7fa9\u3057\u305f\u3002QOL\u306fEQ-5D-5L\u3092\u7528\u3044\u3066\u6e2c\u5b9a\u3055\u308c\u3001\u526f\u4f5c\u7528\u306f\u3001\u9ad8\u8840\u5727\u75c7\u306b\u5bfe\u3059\u308bRevised Illness Perception Questionnaire\u3092\u7528\u3044\u306624\u306e\u9805\u76ee\u304b\u3089\u767a\u751f\u304c\u306a\u3044\u304b\u78ba\u8a8d\u3057\u305f\u3002\u91cd\u7be4\u306a\u6709\u5bb3\u4e8b\u8c61\u306b\u306f\u3001\u6b7b\u4ea1\u307e\u305f\u306f\u751f\u547d\u3092\u8105\u304b\u3059\u3082\u306e\u3068\u5b9a\u7fa9\u3055\u308c\u3001\u5165\u9662\u3092\u5fc5\u8981\u3068\u3057\u305f\u3082\u306e\u307e\u305f\u306f\u65e2\u5b58\u306e\u5165\u9662\u3092\u9577\u671f\u5316\u3055\u305b\u305f\u3082\u306e\u3001\u6301\u7d9a\u7684\u3082\u3057\u304f\u306f\u91cd\u5927\u306a\u969c\u5bb3\u3092\u3082\u305f\u3089\u3057\u305f\u3082\u306e\u3001\u307e\u305f\u306f\u524d\u8ff0\u306e\u3044\u305a\u308c\u304b\u306e\u30ea\u30b9\u30af\u306b\u3055\u3089\u3059\u304b\u3001\u307e\u305f\u306f\u767a\u751f\u3092\u9632\u6b62\u3059\u308b\u305f\u3081\u306e\u4ecb\u5165\u3092\u5fc5\u8981\u306a\u3082\u306e\u3068\u3057\u305f\u3002<\/p>\n

Result
\nPrimary outcome\u306f12\u9031\u76ee\u306e\u8ffd\u8de1\u6642\u306e\u53ce\u7e2e\u671f\u8840\u5727\u304c150mmHg\u672a\u6e80\u3067\u3042\u3063\u305f\u306e\u306f\u3001\u6e1b\u85ac\u7fa4229\u4f8b\uff0886.4\uff05\uff09\u3001\u901a\u5e38\u30b1\u30a2\u7fa4236\u4f8b\uff0887.7\uff05\uff09\u3067\u3042\u308a\u3001\u964d\u5727\u5264\u306e\u6e1b\u85ac\u306f\u901a\u5e38\u306e\u30b1\u30a2\u3068\u6bd4\u3079\u3066\u52a3\u3089\u306a\u3044\u3053\u3068\u3092\u793a\u3057\u3066\u3044\u305f\u3002
\nSecondary outcome\u306f12\u9031\u76ee\u306e\u53ce\u7e2e\u671f\u8840\u5727\u306f\u3001\u4ecb\u5165\u7fa4\u306e\u65b9\u304c3.4 mmHg\u9ad8\u304f\u3001\u865a\u5f31\u6027\u3001QOL\u3001\u526f\u4f5c\u7528\u3001\u91cd\u7be4\u306a\u6709\u5bb3\u4e8b\u8c61\u306b\u3064\u3044\u3066\u306f\u7d71\u8a08\u5b66\u7684\u306b\u6709\u610f\u306a\u5dee\u306f\u898b\u3089\u308c\u306a\u304b\u3063\u305f\uff08\u4ee5\u4e0b\u8868\u53c2\u7167\uff09\u3002<\/p>\n

Discussion
\n\u8907\u6570\u306e\u964d\u5727\u5264\u3092\u51e6\u65b9\u3055\u308c\u3066\u3044\u308b\u9ad8\u9f62\u8005\u3092\u5bfe\u8c61\u3068\u3057\u305f\u672c\u975e\u52a3\u6027\u7121\u4f5c\u70ba\u5316\u81e8\u5e8a\u8a66\u9a13\u3067\u306f\u3001\u901a\u5e38\u306e\u6cbb\u7642\u3068\u6bd4\u8f03\u3057\u3066\u964d\u5727\u85ac\u306e\u6e1b\u91cf\u306f\u300112\u9031\u9593\u5f8c\u306e\u53ce\u7e2e\u671f\u8840\u5727\u304c150mmHg\u672a\u6e80\u306e\u60a3\u8005\u306e\u5272\u5408\u306b\u95a2\u3057\u3066\u975e\u52a3\u6027\u304c\u793a\u3055\u308c\u305f\u3002\u3057\u304b\u3057\u672c\u7814\u7a76\u306b\u306f\u3044\u304f\u3064\u304b\u306e\u9650\u754c\u304c\u793a\u5506\u3055\u308c\u308b\u3002
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\n\u4ee5\u4e0a\u306e\u7d50\u679c\u304b\u3089\uff0c\u9577\u671f\u7684\u306a\u81e8\u5e8a\u7d50\u679c\u3092\u8a55\u4fa1\u3059\u308b\u305f\u3081\u306b\u306f\u3001\u4eca\u5f8c\u3055\u3089\u306a\u308b\u7814\u7a76\u304c\u5fc5\u8981\u3067\u3042\u308b\u304c\uff0c\u4e00\u90e8\u306e\u9ad8\u9f62\u306e\u9ad8\u8840\u5727\u60a3\u8005\u306b\u304a\u3044\u3066\u306f\uff0c\u8840\u5727\u30b3\u30f3\u30c8\u30ed\u30fc\u30eb\u306b\u5927\u304d\u306a\u5909\u5316\u3092\u4f34\u308f\u305a\u306b\u964d\u5727\u85ac\u306e\u6e1b\u91cf\u304c\u53ef\u80fd\u3067\u3042\u308b\u3053\u3068\u304c\u793a\u3055\u308c\u305f\u3002<\/p>\n

\"JC\u897f\u5712\uff11\"<\/a><\/p>\n

\"JC\u897f\u5712\uff12\"<\/a><\/p>\n

\u3010\u958b\u50ac\u65e5\u30112020\u5e748\u67085\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 \uff0d\u6587\u732e\u540d\uff0d James P. Sheppard, et al. Effect of … \u7d9a\u304d\u3092\u8aad\u3080 \u9ad8\u9f62\u8005\u306e\u964d\u5727\u5264\u306e\u6e1b\u85ac\u306b\u3064\u3044\u3066<\/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":[33,17,11],"tags":[],"class_list":["post-1962","post","type-post","status-publish","format-standard","hentry","category-whats-new","category-17","category-11"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1962","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=1962"}],"version-history":[{"count":3,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1962\/revisions"}],"predecessor-version":[{"id":1968,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/1962\/revisions\/1968"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1962"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1962"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1962"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}