著者

森 興太 岡田 靖

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.36, no.2, pp.62-66, 2019 (Released:2019-08-02)

参考文献数

15

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Hypertension is the major risk factor for stroke. In the Hisayama study, the risks of cardiovascular disease increased significantly from the lower range (120–129/80–84 mmHg) of prehypertension in a general Japanese population. Since the clinical trial SPRINT demonstrated that targeting a systolic blood pressure of less than 120mmHg reduced fatal and nonfatal major cardiovascular events, blood pressure goals in patients with hypertension currently tend to be more intensive. However, we should conduct more careful antihypertensive treatment when setting blood pressure target in the elderly or patients with cerebral artery stenosis. The meta–analysis including the majority studies for primary stroke prevention has shown that reducing LDL cholesterol with statins reduces the risk of stroke, therefore statin therapy is recommended for patients with dyslipidemia, especially having diabetes mellitus. Early detection and treatment of atrial fibrillation are valuable prevention for stroke risk reduction in the elderly. Anticoagulation should be considered even for the patients with atrial fibrillation (CHADS2 0 or 1) and other vascular risk factors. Regarding primary prevention of stroke for patients with asymptomatic cerebral atherosclerosis and silent lacunar infarction, intensive management of vascular risk factors such as hypertension and diabetes mellitus is the most important treatment for stroke prevention, and antiplatelet therapy should be taken into considered only in patients with high risk of ischemic stroke.It is also essential to educate and enlighten the knowledge of stroke risk factors and warning signs to the general public.

著者

杉森 宏 森 興太 矢坂 正弘 岡田 靖

出版者

一般社団法人 日本老年医学会

雑誌

日本老年医学会雑誌 (ISSN:03009173)

巻号頁・発行日

vol.59, no.3, pp.305-311, 2022-07-25 (Released:2022-09-07)

参考文献数

14

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高齢者では転倒・転落による死亡者数は不慮の事故の中で最も多い.抗血栓療法は循環器疾患をそしてそれに伴う転倒も予防するが,同時に出血を宿命的に合併する.転倒は患者側の原因と環境原因が重なって起こることを認識してリスクを評価し,転倒リスクに関連する薬剤の処方などを抑制する.また適応があるなら新規経口抗凝固薬などより安全な薬剤を処方し,極端に虚弱な患者には抗血栓療法を控えることも考慮するなど総合的な対応が重要である.