빈혈성 운동승압시험 및 및 본능성 고혈압증의 발생기서에 대한 역학적 고찰 = Ischemic Exercise Pressor Test빈혈성 운동승압시험 및 및 본능성 고혈압증의 발생기서에 대한 역학적 고찰

다국어 초록 (Multilingual Abstract)

The pressor responaes to exerclae of an iachemic arm were studied in 200 normotansive and 100 essential hypertensive subjects by means of the maximal ischemic exercise pressor test to esxamine the in dividual difference of cardiovascular responses, with special reference to the pressor components of hypertensive subjects were carried out. Thus an epidemiological approach to the pathogenesis of essential hypertension was investigated. The results may be summarized as follows: 1) The pressor responses to similar ischemic exercise were qualitatively identical but quantitatively different among subjects while the pressor response in each individual was quite reproducible. 2) The blood pressure increased in tow phases, The initial rise was associated with the mental tension and concentration at the beginning of exercise, and the second on the intensity of muscular work as well as on the pain sensation. Therefore the total pressure rise represents a summation of the multiple reflex sympathetic activities. 3) The ischemic exercise pressor test (submaximal ) consisted of complex pressor components-mental tension, concentration, muscular work, muscular fatigue and muscular pain-represented an episode of moderate mental and physical stresses of the ordinary daily life. 4) Diastolic pressure rise in this test may serve as an index to indicate the degree of peripheral vasoconstriction, that is the activity of vasomotor nerves. 5) This test can be used as a clinical method fortelling an individual pressor response to the moderate life stress. 6) Most of the patients with essenial hysystolic as well as in diastolic pressure, which may reflect an overaction of the vasomotor nerves. Such an overaction of the vasomotor nerves may play an important role in the initiation of essential hypertension. 7) Among normotensive subjects, those who had over 40/30 mmHg (△ syst. Pr./ △ diast. Pr.) in the pressor response and simultaneously over 160/95 or 150/100mmHg in the absolute blood pressure to the submaximal exercise test were considered to be hypertensive response. According to WHO criteria, about 22% of noirmotensives exhibited hypertensive reponse. They may be considered as the owner of neurovascular predisposition susceptible to the development of essential hypertension. Accorrdingly, this technique may be adopted for differentiating the subjects with hypertensive diathesis from the normotensives. In addition, these values may be used in clinical test as criteria for the diagnosis of pre-, early or latent essential hypertension. 8) Excitable or short temper, worrying, highly chivalrous, fretful and tenacious temperaments, timidity and fear or aggressive character were considered as hypertension inducing characters. These characters, more or less, were found in about 97% of the patients with essential hypertension. 9) It is proposed that essential hypertension is a product of the combination of intrinsic or genetic factors, mainly biological neurovascular pressor responsiveness and personal character, and extrinsic or environmental factors, mainly emotional stress and excessive intake of salt. In addition, other contributing fators such as gain of body weight, physical overexertion or alcohol drinking habit may help the development and progress of essential hypertension. Accordingly, essential hypertension is a by-product derived from disharmony, resulting from the interrelation among the multiple factors, of the biological hemodynamic response to life stress. 10) The ischemic exercise pressor test (submaximal) developed by the author can be recommended as a simple technique for an epidemiological approach to the pathogenesis of essential hypertension.