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薬理と治療
Abstract
Background The safety and efficacy of cilnidipine have not been investigated in a large number of post-stroke hypertensive patients. Method Post-marketing surveillance of cilnidipine was conducted in nearly 3000 post-stroke hypertensive patients from May 2011 to June 2013. Results In 2667 patients matched to the criteria of this surveillance protocol, the average age was 69.0 years, and 60.4% were males. The clinical subtype of stroke was cerebral infarction in 80.6% of patients, cerebral hemorrhage in 12.7%, and subarachnoid hemorrhage in 8.4%. The incidence of side effects was 2.6% during one year of observation on cilnidipine treatment. The percentage of patients with well-controlled blood pressure defined by both clinic and morning home readings was 11.2%, using an angiotensin receptor blocker alone, and increased to 43.7%(P<0.01)in combination with cilnidipine. Cilnidipine improved the ratio of morning (predominantly)hypertension, defined as the morning and evening blood pressure at home, from 17.8% to 4.8%(P<0.01). In summer, the home systolic blood pressure(MHSBP)was 142.2±17.7 mmHg before cilnidipine, and in winter, it was 150.2±16.2 mmHg. MHSBP in winter was higher than that in summer(P<0.01). In the winter following the first year, MHSBP was 135.3±11.7 mmHg(P<0.05). Conclusion Cilnidipine well controlled not only morning home blood pressure, a strong risk factor for stroke recurrence, but diurnal variation of blood pressure. Many patients in this surveillance had lifestyle-related risk factors(smoking and obese). In managing these patients, consideration about seasonal variation of morning home blood pressure and lifestyle improvement instruction will be important.
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