Mirror PDF: 高齢者のための高血圧診療

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Title:Mirror PDF: 高齢者のための高血圧診療
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EBMの大家 2人の賢者が語る「高齢者医療トピック」 「高血圧は危険だ(心配)」 「140mmHgは高血圧だ(どうにかしたい)」 「血圧は下げるべきだ(下げたい)」 これらの個々の患者が述べる希望や医者が示す治療指針も 「個別性」の話というより、移ろいゆく世の中の、 ごく一般的な平均値に過ぎないかもしれません 全ての物事が曖昧な中で決まっていく。「適当に」どうにか収まっていくとしたら、 そこにあるのは「関係性」であって、 「血圧は測らなくてもいいし」 「血圧は下げなくてもいい」 「もちろん測ってもいいし」 「降圧薬飲んでもいいし」 「どちらでもいい」 という捉え方も「有り」でしょう 高血圧マネジメントだけでなく、安楽死、ACP、意思決定の在り方など、 今医師は、どういう臨床を提供すべきなのか… 今読んでおくべき、アンチな教科書としての「誇り」が、この本にはあります ----- 目次 第1部 総 論 1章 高齢化と血圧の関係(リスクとしての高血圧) 2章 高齢者の高血圧の問題とは何か(さまざまなPECO) 3章 ガイドラインはどうなっているか(日本のガイドライン、欧米のガイドライン) 第2部 各 論(必須の論文を押さえながら) 4章 高齢者の血圧に影響する因子とその対応 5章 高齢者血圧の治療効果 6章 多様な疾患の中での高血圧治療(糖尿病,慢性腎臓病,二次予防,フレイル) 7章 高血圧のエビデンスから高血圧の診療へ:個別性から関係性へ 8章 高齢者高血圧の診療の実際へ向けて 第3部 極 論(世の中のでたらめに一言) 9章 認知症と高血圧 10章 血圧が高いと救急外来を受診する高齢者 11章 ポリファーマシーにはこう介入する 12章 介護施設における高血圧管理(デイサービス,入浴前の血圧測定) 13章 終末期ケアと血圧(終末期の対応,中止時の不安、低血圧の問題) 14章 高齢者が血圧を測らない世の中 第4部 対 談 15章 対談:高血圧編 16章 対談:意思決定編 17章 対談:世の中編 付録 高齢者高血圧の勉強法(論文を読まずに診療できるのか) つぶやきコラム一覧 アウトカムのいろいろ/ フォレストプロット/ サブグループ分析/ 予防か,先送りか/ 高齢の認知症患者における降圧薬の有無による血圧と認知機能の関係/ 製薬メーカーのはっきりした利益が他を圧倒する/ ガイドラインではどうか…?/ 寿命が重要なアウトカムでなくなるとき.
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