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運動負荷中及び終了後の中心血圧測定による心血管リスク評価の有効性の検討
大阪教育大学宮 井 信 行（共同研究者） 和歌山県立医科大学

有 田 幹 雄同森 岡 郁 晴

同宮 下 和 久Central Blood Pressure Measurement During and After Dynamic Exercise
for Evaluating Risks of Cardiovascular Diseases

byNobuyuki Miyai
Osaka Kyoiku University
Mikio Arita, Ikuharu Morioka, Kazuhisa Miyashita
Wakayama Medical UniversityABSTRACT
The aim of this study was to assess the central blood pressure response to exercise withrisks of cardiovascular diseases associated with hypertension. Thirty-four male volunteers（aged 51 ± 7 years; mean ± s.d.）who were free from cerebrovascular and cardiovasculardiseases, diabetes mellitus and renal diseases were examined. The subjects underwent a
graded symptom-limited submaximal exercise test on bicycle ergometer. At baseline,
during and after the cycle exercise, peripheral pulse waveforms were recorded by a radialapplanation tonometry. Central （ascending aortic ）pressure waveforms were thenestimated using a generalized transfer function. Pulse pressure amplification, defined as theデサントスポーツ科学 Vol. 30

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ratio of peripheral to central pulse pressure, was used as a marker of wave reflection.
Compared to the baseline, pulse pressure amplification significantly increased during
exercise, and after the exercise it gradually decreased to the baseline level. We divided thesubjects into subgroups according to the presence or absence of hypertension, dyslipidemia
and glucose intolerance. Throughout the exercise test, pulse pressure amplifications in thesubjects with hypertension and those with multiple risk factors, including hypertension
together with at least one of dyslipidemia and glucose intolerance, were significantly lower
than those with normal blood pressure. Furthermore, the subjects with multiple risk factors
had significantly reduced pulse pressure amplification after exercise compared to thosewith hypertension alone. In multiple regression analysis, the post-exercise pulse pressure
amplification was independently associated with age and the presence of multiple risk
factors including hypertension. There was a significant correlation between post-exercise
pulse pressure amplification and left ventricular mass index.
These results suggest that pulse pressure amplification is associated with thehypertension, dyslipidemia and glucose intolerance, and with increased left ventricularmass. Thus, the measurement of central blood pressure during and after exercise may be
useful in investigating the hypertension-related risks of cardiovascular diseases.

要 旨群，多重リスク群（高血圧＋脂質代謝異常かつ/または耐糖能異常）に分けて比較すると，高血圧本研究は，運動負荷中及び終了後の中心血圧測群と多重リスク群の amplification は負荷試験中の定から得られるパラメータが心血管リスクの評価いずれの測定点においても正常血圧群に比べて有に有用であるかを検討することを目的とした．成意に低値を示した．高血圧群と多重リスク群の比人男性 34 名（平均年齢 51 . 2 ± 7 . 2 歳）を対象に，

較では，負荷前と負荷中の amplification に差はな

自転車エルゴメーターによる運動負荷試験を多段かったが，負荷後においては多重リスク群が有意階漸増負荷法で実施した．負荷試験中は右上腕部に低値であった．また，負荷後の amplification をより血圧を連続的に測定するとともに，トノメト従属変数としたステップワイズ法による重回帰分リ法により橈骨動脈血圧波形の記録を行った．さ析では，年齢，高血圧を含む多重リスクの有無がらに，この波形を伝達関数により大動脈起始部血独立の決定因子であった．さらに，負荷後の圧波形に変換して中心血圧を求めた．また，橈骨

amplification と左室心筋重量係数との間には有意動脈と大動脈の脈圧比（amplification）を脈波にな相関関係が認められた．

おける反射指数として用いた． amplification は，以上のことから，運動負荷試験中に橈骨トノメ負荷前に比べ負荷中及び終了直後では有意に上昇

トリ法で測定した中心血圧のパラメータは，高血し，負荷後は徐々に低下して負荷前のレベルに戻圧を含む脂質代謝異常や耐糖能異常の集積の有無，る傾向にあった．高血圧，脂質代謝異常，耐糖能あるいは左室肥大の程度と関連し，心血管リスク異常の有無により，対象者を正常血圧群，高血圧の評価において有用である可能性が示された．
デサントスポーツ科学 Vol. 30