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異なる高血圧表現型における情緒的気質と動脈硬化の評価
Evaluation of affective temperaments and arterial stiffness in different hypertension phenotypes.
PMID: 32681161 DOI: 10.1038/s41440-020-0513-2.
抄録
感情的気質（抑うつ性、不安性、過敏性、多汗性、循環性）は、パーソナリティの安定した部分であり、外部刺激に対する感情的な反応性を表す。これらの気質と精神病理学的状態との関係は明らかであるが、心血管疾患との関係についてはデータが少ない。本研究の目的は，健常者（Cont），白衣高血圧患者（WhHT），非抵抗性高血圧患者（非ResHT）および抵抗性高血圧患者（ResHT）における情緒的気質と血行動態および動脈硬化パラメータを評価することであった．この横断的研究には 363 人の患者が含まれていた。Cont82人、WhHT44人、non-ResHT200人、ResHT37人であった。患者はメンフィス、ピサ、パリ、サンディエゴのテンペラメント評価（TEMPS-A）を記入し、トノメトリー（PulsePen）を用いて動脈硬化を調べた。脈波伝播速度は、Cont群、WhHT群、非ResHT群、ResHT群の間で有意差が認められた（それぞれ7.76±0.96、8.13±1.39、8.98±1.25、10.18±1.18m/s、Cont群と非ResHT/ResHT群の間ではp<0.05、非ResHTとResHT群の間ではp<0.05）。サイクロシー情緒気質点（4点（2.25～8点））は、Cont群（2点（0～5点）、非ResHT群（3点（1～5点））に比べてResHT群の方が高かった（p＜0.05）。また、WhHT群（4（2～7））のサイクロシー気質点もCont群に比べて高かった。ResHTは、6点以上のサイクロシー性尺度得点（β=2.59（95％CI：1.16～5.77））、7点以上の過敏性尺度得点（β=3.17（95％CI：1.3～7.69））、および9点以上の不安性尺度得点（β=2.57（95％CI：1.08～6.13））と独立して関連していた。また、WhHTは6点以上のcyclothymic scale scoreと独立して関連していた（β=2.378、95％CI：1.178-4.802）。結論として、WhHT患者とResHT患者は特定の情動的気質パターンを有しており、これらのパターンを評価することは、これらの病態の精神病理学的背景を理解するのに役立つと考えられる。
Affective temperaments (depressive, anxious, irritable, hyperthymic, and cyclothymic) are stable parts of personality and describe emotional reactivity to external stimuli. Their relation to psychopathological conditions is obvious, but less data are available on their relationship with cardiovascular disorders. The aim of this study was to evaluate affective temperaments and hemodynamic and arterial stiffness parameters in healthy subjects (Cont), in white-coat hypertensive (WhHT) patients, and in non-resistant (non-ResHT) and resistant hypertensive (ResHT) patients. In this cross-sectional study, 363 patients were included: 82 Cont, 44 WhHT, 200 non-ResHT, and 37 ResHT. The patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and arterial stiffness was examined with tonometry (PulsePen). Significant differences were found between the Cont, WhHT, non-ResHT and ResHT groups in pulse wave velocity (7.76 ± 0.96, 8.13 ± 1.39, 8.98 ± 1.25, and 10.18 ± 1.18 m/s, respectively, p < 0.05 between Cont and non-ResHT/ResHT; p < 0.05 between non-ResHT and ResHT). Cyclothymic affective temperament points (4 (2.25-8)) were higher (p < 0.05) in the ResHT group than in the Cont (2 (0-5)) and non-ResHT (3 (1-5)) groups. The cyclothymic temperament points of the WhHT group (4 (2-7)) were also higher than those in the Cont group. ResHT was independently associated with a cyclothymic scale score above 6 (beta = 2.59 (95% CI: 1.16-5.77)), an irritable scale score above 7 (beta = 3.17 (95% CI: 1.3-7.69)) and an anxious scale score above 9 (beta = 2.57 (95% CI: 1.08-6.13)) points. WhHT was also independently associated with cyclothymic scale scores above 6 points (beta = 2.378, 95% CI: 1.178-4.802). In conclusion, white-coat and ResHT patients have specific affective temperament patterns, and the evaluation of these patterns can help to understand the psychopathological background of these conditions.