- 學位論文
使用非侵入性血流動力學監測angiotensin receptor blockers（ARB）類藥物對原發性高血壓病患之治療影響
Study on the relationship between noninvasive hemodynamic monitoring and ARB on blood pressure control in patients with essential hypertension
摘要
研究背景與動機：根據國民健康署統計，2017年至2020年我國18歲以上國人高血壓盛行率達26.76%，相較前一次調查再增加1.61％。高血壓導致的心血管疾病死因，如心臟疾病、腦血管疾病及高血壓性疾病等，分別列在十大死因第2位、第4位及第6位；高血壓性疾病排名由第8位上升至第6位，顯現高血壓人口及其共病有增加的趨勢。 臨床重要性：目前臨床降血壓藥物調整，各家指引藥物使用方向略同，但仍倚重主治醫師用藥經驗及病患病況，調整藥物。本研究利用血液動力學監測儀器，收集Systemic vascular resistance (SVR)指數及各項血液動力學數值，提供給門診醫師調整angiotensin receptor blockers (ARB) 藥物使用，加速病患血壓控制至正常值。 研究方法：本研究由門診收案108位高血壓患者，在門診看診前，由護理師協助使用ICON測量血液動力學相關指標，主治醫師評估病患居家血壓與SVR、Cardiac index (CI)指數指數，調整藥物。收案病患分為兩組，一組為有增加或減少ARB藥物劑量，另一組無調整ARB藥物劑量。兩組病患服用藥物兩個月後，再次以相同方式測量血液動力學各項指標及血壓。 研究結果：控制血壓的部分，平均收縮壓在異常SVR調整藥物組別中下降程度有統計上的意義（p = 0.0097）；心收縮指數ICON在平均值與增加的百分比皆有統計意義（p=0.0034）。代表後負荷指數的SVR減少的幅度，則是在有調整藥物的組別有統計上的意義（p = 0.0006）。 結論與建議：使用體外心輸出監測儀器取得SVR數值後，針對SVR高低來調整ARB類藥物，收縮壓改善幅度明顯，對於恢復周邊血管阻力回到正常值及增加病患的心臟收縮綜合指數ICON皆有顯著效果。因此針對每位患者的血液動力學異常值，進而個人化病患抗高血壓藥物治療方向，可縮短病患調整高血壓藥物組合，縮短達到為值目標血壓的時間，並增加病患規則服藥依順性。
並列摘要
Research background and objectives: According to the announcement of the Health Promotion Administration, from 2017 to 2020, the prevalence rate of hypertension among Taiwanese over the age of 18 years reached 26.76%, an increase of 1.61% compared to the previous survey. In particular, cardiovascular disease causes of death by hypertension, such as heart disease, cerebrovascular disease, hypertensive diseases, are listed as the second, fourth, and sixth among the top ten causes of death, respectively. The hypertension ranking increased from No. 8 to No. 6, showing that the population of hypertensive patients and their comorbidities is increasing. Clinical significances: At present, in the adjustment of clinical antihypertensive drugs, the guidelines for the use of drugs are the same, but still rely on the experience of the attending physician and the condition of the disease. In the present study, a noninvasive hemodynamic monitoring device was used to collect the SVR index and various hemodynamic parameters and provide them to outpatient physicians to adjust the use of ARB drugs. These data were used to accelerate the control of blood pressure in patients to normal values. Methods: 108 hypertensive patients were enrolled in the outpatient clinic in this study. Before outpatient visit, nurses helped measure hemodynamic parameters using ICON, and the attending physician evaluated the patient's blood pressure, SVR, and CI index and adjusted the drugs. The admitted patients were divided into two groups, one group had increased or decreased the ARB drug dosage, and the other group had no adjustment in the dosage of ARB drugs. Two months after taking the drug, hemodynamic parameters and blood pressure were again measured in the same way. Results: As part of blood pressure control, mean systolic blood pressure decreased statistically in the abnormal SVR-adjusted drug group (p = 0.0097). The systolic index ICON was statistically significant both in the mean value and in percentage increase (p=0.0034). The reduction in SVR, which represents the afterload index, was statistically significant in the group with the adjusted drug (p = 0.0006). Conclusions: After obtaining the SVR value with a noninvasive cardiac output monitoring instrument, adjusting ARB drugs according to the level of SVR can significantly improve systolic blood pressure, which shows a significant effect in restoring peripheral vascular resistance back to normal and increasing the patient's comprehensive systolic index ICON. Therefore, according to the hemodynamic abnormal value of each patient and then personalize the direction of the antihypertensive drug treatment, it can shorten the time for the patient to adjust the hypertension drug combination, reduce the time to reach the target blood pressure, and increase the patient's regular medication compliance.