心血管系疾患とレニン・アンジオテンシン系 ―新世代アンジオテンシンII受容体拮抗薬による検証―

出版社： 先端医学社
著者：
発行日： 2000-09-05
分野： 臨床医学：内科  >  循環器一般
ISBN： 9784884070083
電子書籍版： 2000-09-05 （第1版第1刷）
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心血管系疾患の病因・病態にかかわり注目される組織RA系を網羅的に解説。
EBM実践のための新世代アンジオテンシンⅡ受容体拮抗薬の情報と心血管系各疾患への臨床応用を多くの治療成績からわかりやすく解説。国内初のAⅡ受容体拮抗薬カンデサルタン　シレキセチルの基礎と最新の臨床成績を収載。

目次

  • 表紙
  • 序
  • 執筆者一覧
  • 目次
  • [1] 心血管系疾患におけるアンジオテンシンII受容体と病態生理
  • 1. レニン・アンジオテンシン系の病態生理とその遮断薬
  • はじめに
  • I. RA系の生理作用
  • II. RA系の異常にもとづく諸病態
  • 1. 高血圧の発症
  • 2. 二次性アルドステロン症
  • 3. 血管再構築および動脈硬化への関与
  • III. RA系の遮断薬
  • 1. AII産生阻害薬
  • 2. AII受容体拮抗薬
  • おわりに
  • 2. 組織レニン・アンジオテンシン系と病態生理
  • はじめに
  • I. 組織アンジオテンシンII産生系の動物種差
  • II. 組織レニン・アンジオテンシン系と高血圧
  • 腎性高血圧モデル
  • III. 組織レニン・アンジオテンシン系と血管肥厚
  • 1. PTCA後再狭窄モデル
  • 2. バイパス狭窄モデル
  • IV. 組織レニン・アンジオテンシン系と動脈硬化
  • おわりに
  • 3. アンジオテンシンII産生系と病態生理
  • はじめに
  • I. カリクレイン型セリンプロテアーゼ
  • トリプシン, カリクレイン, トニン, カテプシンGの病態生理
  • II. キマーゼ型セリンプロテアーゼ
  • III. キマーゼ型セリンプロテアーゼの病態生理
  • 1. 心筋症と心不全
  • 2. 心筋梗塞
  • 3. 左室肥大
  • 4. 高血圧
  • 5. 動脈硬化
  • おわりに
  • 4. アンジオテンシンII受容体の分類と病態生理
  • はじめに
  • I. アンジオテンシン受容体のサブタイプ
  • 1. AT1受容体
  • 2. AT2受容体
  • 3. そのほかのアンジオテンシン受容体
  • II. AT1受容体, AT2受容体の発現バランスにより心血管系リモデリングが調節される
  • III. AT1受容体, AT2受容体のシグナルはクロストークし, その生理活性に拮抗作用を示す
  • 5. レニン・アンジオテンシン系遺伝子と心血管系疾患
  • はじめに
  • I. レニン・アンジオテンシン系遺伝子と循環器系病
  • 1. レニン遺伝子
  • 2. アンジオテンシノーゲン遺伝子
  • 3. アンジオテンシン変換酵素(ACE)遺伝子
  • 4. アンジオテンシンII受容体遺伝子
  • II. 遺伝子診断による予知予防医学
  • おわりに
  • [2] アンジオテンシンII受容体拮抗薬の薬理
  • 1. アンジオテンシンII受容体拮抗薬開発の経緯
  • はじめに
  • I. レニン・アンジオテンシン系と薬剤
  • II. ベンジルイミダゾール酢酸の発見
  • III. ロサルタンの発見
  • IV. カンデサルタンの発見
  • V. カンデサルタンの化学構造と薬理学的特徴
  • VI. カンデサルタン シレキセチルの合成と薬物作用
  • VII. 新規ARBの研究開発
  • おわりに
  • 2. アンジオテンシンII受容体拮抗薬の基礎薬理
  • はじめに
  • I. カンデサルタン シレキセチルの薬理作用
  • 1. アンジオテンシンII受容体拮抗作用
  • 2. 細胞内伝達系に対する作用
  • 3. 血管収縮に対する抑制作用
  • 4. AII昇圧抑制作用
  • 5. アルドステロン遊離抑制作用
  • 6. 細胞増殖抑制作用
  • 7. 交感神経の伝達抑制
  • 8. レニン・アンジオテンシン系に対する作用
  • 9. アンジオテンシン受容体拮抗薬の降圧作用
  • II. カンデサルタン シレキセチルの薬理特性とその意義
  • III. アンジオテンシンII受容体拮抗薬の臓器障害に対する作用
  • 1. 脳卒中
  • 2. 心不全に対する作用
  • 3. 腎障害に対する作用
  • おわりに
  • 3. アンジオテンシンII受容体拮抗薬の薬理学的特徴
  • はじめに
  • I. AT1受容体拮抗薬の薬理作用-in vivoを中心に-
  • 1. 心保護作用の機序
  • 2. 血管保護作用の機序
  • 3. 腎保護作用の機序
  • II. AT2受容体拮抗薬の薬理作用
  • III. AT1受容体拮抗薬とACE阻害薬の比較
  • 1. 薬理作用の相違点
  • 2. 併用の可能性
  • おわりに
  • 4. アンジオテンシンII受容体拮抗薬の臨床応用―ペプチド性アナログからカンデサルタン シレキセチルの初期臨床試験まで―
  • はじめに
  • I. アンジオテンシンIIアナログペプチドの臨床応用
  • II. 初期ベンジルイミダゾール酢酸化合物CV-2973の臨床試験
  • III. カンデサルタン シレキセチル(TCV-116)の臨床応用
  • IV. 健常人における外因性AII昇圧反応抑制作用の証明
  • V. カンデサルタン シレキセチル(TCV-116)の前期第II相臨床試験
  • 5. アンジオテンシンII受容体拮抗薬の代謝・薬物動態
  • はじめに
  • I. 薬物体内動態
  • 1. ロサルタンの健常成人における薬物体内動態
  • 2. カンデサルタンシレキセチルの本態性高血圧症患者における薬物体内動態
  • II. 腎障害患者における薬物体内動態
  • 1. ロサルタンの腎障害患者における薬物体内動態
  • 2. カンデサルタン シレキセチルの腎障害患者における薬物体内動態
  • III. AII受容体拮抗薬の代謝とCYP2C9
  • IV. AII受容体拮抗薬の体外排出
  • おわりに
  • [3] アンジオテンシンII受容体拮抗薬による高血圧の治療
  • 1. 本態性高血圧とレニン・アンジオテンシン系
  • はじめに
  • I. 循環レニン・アンジオテンシン系の概略
  • II. アンジオテンシンIIの作用
  • III. 血漿レニン活性と本態性高血圧
  • 1. レニン・サブグループの特徴
  • 2. 心血管系疾患とPRA
  • IV. レニン・アンジオテンシン系遺伝子多型と高血圧
  • 1. アンジオテンシノーゲン遺伝子
  • 2. ACE遺伝子
  • おわりに
  • 2. 高血圧治療とアンジオテンシンII受容体拮抗薬―開発から臨床応用, 特徴―(わが国における臨床成績より)
  • はじめに
  • I. レニン・アンジオテンシン系
  • II. レニン・アンジオテンシン系の病態生理
  • III. アンジオテンシンII受容体拮抗薬の登場
  • 1. ペプチド性拮抗薬
  • 2. 非ペプチド性拮抗薬
  • IV. アンジオテンシンII受容体拮抗薬の効果
  • 1. 降圧効果
  • 2. 臓器保護作用
  • 3. ACE阻害薬との併用効果
  • 4. 今後の展望
  • おわりに
  • 3. アンジオテンシンII受容体拮抗薬の降圧薬としての位置付け―治療指針, ガイドラインより―
  • はじめに
  • I. 国際的高血圧治療ガイドラインにおけるAII受容体拮抗薬の位置付け
  • II. AII受容体拮抗薬とACE阻害薬の薬理作用の比較
  • III. 本態性高血圧患者におけるAII受容体拮抗薬の降圧効果
  • IV. 本態性高血圧患者におけるAII受容体拮抗薬の安全性
  • V. 降圧薬併用療法におけるAII受容体拮抗薬の位置付け
  • おわりに
  • 4. 血圧日内変動とアンジオテンシンII受容体拮抗薬
  • はじめに
  • I. 血圧日内変動における降圧薬の役目
  • II. ロサルタンの血圧日内変動に及ぼす影響
  • III. カンデサルタンの血圧日内変動に及ぼす影響
  • 1. 臨床第II相前期試験
  • 2. 外来患者における検討
  • IV. バルサルタンの血圧日内変動に及ぼす影響
  • V. カンデサルタンとロサルタン24時間血圧測定による評価
  • VI. カンデサルタンの48時間後の降圧効果
  • VII. カンデサルタンのエナラプリルを対照薬とした二重盲検群間比較試験
  • おわりに
  • 5. 老年者高血圧とアンジオテンシンII受容体拮抗薬
  • はじめに
  • I. 老年者高血圧の治療成績
  • II. ACE阻害薬を用いた高血圧介入試験成績
  • III. 老年者高血圧治療におけるACE阻害薬の評価
  • IV. AT1受容体拮抗薬と高血圧治療
  • V. 老年者高血圧治療におけるAT1受容体拮抗薬
  • おわりに
  • 6. 代謝異常を合併した高血圧とアンジオテンシンII受容体拮抗薬―インスリン感受性への効果含む―
  • はじめに
  • I. カンデサルタンのインスリン感受性, 糖代謝に及ぼす影響
  • 1. 降圧薬の糖代謝への影響の重要性
  • 2. カンデサルタンのインスリン感受性への影響
  • 3. カンデサルタンの糖代謝への影響
  • II. アンジオテンシンII受容体拮抗薬の脂質代謝に及ぼす影響
  • 1. 脂質代謝異常とインスリン抵抗性の関与
  • 2. アンジオテンシンII受容体拮抗薬の脂質代謝に及ぼす影響
  • おわりに
  • [4] 心疾患とアンジオテンシンII受容体拮抗薬
  • 1. 心肥大・リモデリングとアンジオテンシンII
  • はじめに
  • I. 心肥大形成におけるアンジオテンシンII(AII)の役割
  • 1. 心肥大とは
  • 2. 心肥大の形成機序
  • II. 発生工学を用いた心臓リモデリングにおけるAIIの役割
  • 1. レニントランスジェニックラット
  • 2. AT1受容体トランスジェニックマウス
  • 3. AT2受容体トランスジェニックマウス
  • 4. AT1受容体ノックアウトマウス
  • おわりに
  • 2. 心不全とアンジオテンシンII受容体拮抗薬
  • はじめに
  • I. 心不全におけるレニン・アンジオテンシン系の賦活化と役割
  • 1. 心不全における循環レニン・アンジオテンシン系
  • 2. 心筋組織レニン・アンジオテンシン系
  • 3. 心臓におけるアンジオテンシンII受容体
  • II. 心不全におけるアンジオテンシンII受容体拮抗薬とACE阻害薬の作用機序の差異
  • 1. キニン・カリクレイン系への影響
  • 2. アンジオテンシンIIの阻害
  • 3. AT2作用の増強
  • III. アンジオテンシンII受容体拮抗薬の心不全に対する効果
  • 1. 予後改善効果
  • 2. 血行動態への影響
  • 3. 心室リモデリングの抑制
  • 4. 不整脈への効果
  • 5. 運動耐容能への影響
  • おわりに
  • 3. 心疾患を伴った高血圧とアンジオテンシンII受容体拮抗薬
  • はじめに
  • I. 心肥大抑制効果
  • II. 左室拡張能ならびに冠血流予備能改善効果
  • III. 心室性不整脈抑制効果
  • IV. 動脈壁伸展性改善効果
  • おわりに
  • [5] 脳循環とアンジオテンシンII受容体拮抗薬
  • 1. アンジオテンシンII受容体拮抗薬の脳循環への影響
  • はじめに
  • I. 脳循環の特殊性
  • 1. 血液脳関門
  • 2. 脳血流自動調節
  • II. アンジオテンシンII受容体と脳循環調節
  • 1. アンジオテンシンIIによる脳血管反応
  • 2. 脳血流自動調節に対するACE阻害薬の効果
  • III. アンジオテンシンII受容体拮抗薬の脳循環への影響
  • IV. アンジオテンシンII受容体拮抗薬の脳血管病変に対する作用
  • おわりに
  • 2. 脳血管障害を伴った高血圧とアンジオテンシンII受容体拮抗薬
  • はじめに
  • I. 脳血管障害と高血圧
  • 1. 脳血管障害の危険因子としての高血圧
  • 2. 高血圧の脳血管, 脳循環への影響
  • 3. アンジオテンシンII受容体拮抗薬の脳血管, 脳循環への効果
  • II. 脳血管障害を伴った高血圧患者の治療
  • 1. 急性期の血圧管理
  • 2. 慢性期の降圧治療
  • 3. アンジオテンシンII受容体拮抗薬の位置付け
  • おわりに
  • [6] 腎疾患とアンジオテンシンII受容体拮抗薬
  • 1. 腎臓とレニン・アンジオテンシン系
  • はじめに
  • I. 傍糸球体装置とレニン分泌調節
  • II. レニン・アンジオテンシン系の腎内濃度
  • III. アンジオテンシンII受容体と腎内作用
  • IV. 圧利尿と高血圧
  • おわりに
  • 2. 腎疾患とアンジオテンシンII受容体拮抗薬
  • はじめに
  • I. 腎疾患の進展とレニン・アンジオテンシン系の遺伝子多型との関連性
  • 1. 糖尿病性腎症
  • 2. IgA腎症
  • II. ACE阻害薬・アンジオテンシンII(AT1)受容体拮抗薬を用いた動物モデルでの検討
  • III. 腎障害を伴う高血圧症患者に対するACE阻害薬とAT1受容体拮抗薬の尿蛋白減少・腎機能保持作用
  • おわりに
  • 3. 腎機能障害を伴った高血圧とアンジオテンシンII受容体拮抗薬
  • はじめに
  • I. 腎機能障害を伴った高血圧のガイドラインとRA系調節薬
  • II. 実験動物でのACE阻害薬とアンジオテンシンII受容体拮抗薬との比較成績
  • III. ヒトでのACE阻害薬とアンジオテンシンII受容体拮抗薬との比較
  • IV. アンジオテンシンII受容体拮抗薬の腎障害時の薬物動態について
  • 1. ロサルタン
  • 2. カンデサルタン シレキセチル
  • 3. イルベサルタン
  • V. アンジオテンシンII受容体拮抗薬の腎障害を伴った高血圧患者での降圧効果と腎機能の変化
  • 1. ロサルタン
  • 2. カンデサルタン シレキセチル
  • 3. バルサルタン
  • おわりに
  • [7] 動脈硬化性疾患とアンジオテンシンII受容体拮抗薬
  • 1. 動脈硬化性疾患とレニン・アンジオテンシン系
  • はじめに
  • I. 動脈硬化のプロセス
  • II. レニン・アンジオテンシン系の動脈硬化促進作用
  • 1. ヒトアンジオテンシノーゲン遺伝子と動脈硬化
  • 2. アンジオテンシンIIと動脈硬化
  • 3. アンジオテンシン変換酵素(ACE)と動脈硬化
  • 4. キマーゼと動脈硬化
  • III. アンジオテンシンII受容体およびアンジオテンシンII受容体拮抗薬
  • 1. AT1受容体と動脈硬化
  • 2. AT2受容体の役割
  • おわりに
  • 2. 血管内皮機能とアンジオテンシンII受容体拮抗薬
  • はじめに
  • I. 血管内皮細胞機能
  • 1. 血管内皮の役割
  • 2. 血管内皮由来の生理活性物質と機能的均衡
  • II. AIIと血管内皮細胞
  • 1. 血管内皮細胞のAII受容体
  • 2. AIIによる内皮細胞障害
  • III. 血管内皮機能低下に対するAT1拮抗薬の効果
  • 1. 高脂血症の血管内皮とAT1拮抗薬
  • 2. 高血圧症の血管内皮とAT1拮抗薬
  • 3. 動脈硬化・血管傷害の血管内皮とAT1拮抗薬
  • おわりに
  • [8] アンジオテンシンII受容体拮抗薬の使い方
  • 1. 単独療法と併用療法(ACE阻害薬との比較)
  • はじめに
  • I. 単独療法
  • II. 併用療法
  • III. 治療の継続性からみたアンジオテンシンII受容体拮抗薬
  • 2. アンジオテンシンII受容体拮抗薬の副作用と使用上の注意
  • はじめに
  • I. AT1受容体拮抗薬の副作用発現頻度
  • II. おもな副作用―ACE阻害薬との比較
  • 1. 空咳
  • 2. 血管性浮腫
  • 3. 貧血
  • III. 投与上の注意点
  • 1. 腎機能障害
  • 2. 利尿薬との併用
  • 3. 高齢者への投与
  • 4. 妊婦への投与禁忌
  • 5. 血液浄化膜によるアナフィラキシー
  • 3. アンジオテンシンII受容体拮抗薬とQOL
  • はじめに
  • I. 高血圧治療におけるAII受容体拮抗薬とQOL
  • II. 心不全治療におけるAII受容体拮抗薬とQOL
  • III. AII受容体拮抗薬とACE阻害薬―咳の副作用の比較―
  • おわりに
  • 4. EBMとアンジオテンシンII受容体拮抗薬―大規模介入試験と進行状況など―
  • はじめに
  • I. 高血圧に関する大規模介入試験
  • 1. LET試験(1998)
  • 2. LIFE研究(進行中)
  • 3. SCOPE(進行中)
  • 4. VALUE試験(進行中)
  • 5. ABCD-2V(進行中)
  • 6. ELHE試験(1998)
  • 7. ACCESS試験(進行中)
  • II. 心不全に関する大規模介入試験
  • 1. ELITE研究(1997)
  • 2. ELITE II研究(1999)
  • 3. RESOLVDパイロット研究(1999)
  • 4. CHARM(進行中)
  • 5. Val-HeFT(進行中)
  • 6. STRETCH(1999)
  • 7. SPICE(1999)
  • III. 急性心筋梗塞に関する大規模介入試験
  • 1. OPTIMAAL(進行中)
  • 2. VALIANT(進行中)
  • IV. 糖尿病に関する大規模介入試験
  • 1. RENAAL(進行中)
  • 2. IDNT(進行中)
  • おわりに
  • 付録 高血圧診療ガイドラインの概要
  • JNC VIガイドライン
  • WHO/ISHガイドライン1999
  • 老年者高血圧ガイドライン(1999年改訂版)
  • 索引
  • 奥付

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本参考文献は電子書籍掲載内容を元にしております。

[1] 心血管系疾患におけるアンジオテンシンII受容体と病態生理

P.7 掲載の参考文献
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P.13 掲載の参考文献
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P.19 掲載の参考文献
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[2] アンジオテンシンII受容体拮抗薬の薬理

P.44 掲載の参考文献
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7) メルク社社内資料
 
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9) カンデサルタン シレキセチルの添付文書
 

[3] アンジオテンシンII受容体拮抗薬による高血圧の治療

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[4] 心疾患とアンジオテンシンII受容体拮抗薬

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[5] 脳循環とアンジオテンシンII受容体拮抗薬

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[6] 腎疾患とアンジオテンシンII受容体拮抗薬

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[7] 動脈硬化性疾患とアンジオテンシンII受容体拮抗薬

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[8] アンジオテンシンII受容体拮抗薬の使い方

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