JP2015062585A - Blood pressure manometer - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a blood pressure manometer capable of determining whether or not a measured blood pressure value is within a reference range according to a degree of deterioration of a kidney function.SOLUTION: A blood pressure manometer (10) includes: a blood pressure measurement part (43); an acquisition part (22) for acquiring a parameter related to a kidney function; a derivation part (47) for deriving a reference blood pressure value according to the parameter acquired by the acquisition part; a comparison part (48) for comparing the blood pressure value measured by the blood pressure measurement part with the reference blood pressure value; and an output part (21) for outputting the result of comparison by the comparison part.

Description

  The present invention relates to a sphygmomanometer.

  There is known an electronic sphygmomanometer that determines whether a measured blood pressure value belongs to a blood pressure category such as “normal blood pressure” or “mild hypertension” and displays the determination result (see, for example, Patent Document 1). ).

  In recent years, there are many cases in which chronic renal failure develops due to high blood pressure. Hypertension and chronic kidney disease (CKD) are inextricably linked, and if high blood pressure continues for a long period of time, the kidneys are burdened and the blood filtration ability of the kidneys deteriorates. When renal function deteriorates, antihypertensive hormones are not secreted, leading to further hypertension, and further falling into a spiral in which renal function is further reduced, which may eventually require artificial dialysis. Therefore, if there are signs of decreased renal function, a lower standard value than the normal blood pressure management standard must be applied. For this reason, the blood pressure management index according to the stage of a renal function fall is separately shown by the nephrology society (for example, refer nonpatent literature 1).

  Chronic kidney disease is divided into five stages, stages 1 to 5, depending on its severity. The index is an estimated Glomerular Filtration Rate (eGFR). This shows how much the kidneys have the ability to excrete waste products into the urine, the lower this value, the worse the kidneys work. The value of eGFR can be obtained from the serum creatinine value, sex, and age in the blood test items of the health checkup, and based on this, it can be determined whether the stage of one's renal function decline is stage 1-5 I can know.

  It is also known that there is a correlation between the average blood pressure value and the decrease in glomerular filtration rate (GFR) (see, for example, Non-Patent Document 1). Specifically, the higher the average blood pressure value, the greater the amount of glomerular filtration rate (GFR) decreased, and the kidney function tends to decrease.

JP 2004-121632 A

Edited by Japanese Society of Nephrology, CKD Medical Guide 2012, Tokyo Medical, 2012

  In the blood pressure classification by the Japanese Society for Hypertension, the maximum blood pressure value is less than 140 mmHg and the minimum blood pressure value is less than 90 mmHg as a normal range. However, this blood pressure reference determination is merely a management index for hypertension alone. Depending on the degree of decrease in the renal function of the person being measured, the criterion that the maximum blood pressure value is less than 140 mmHg and the minimum blood pressure value is less than 90 mmHg may be too high. For this reason, if blood pressure is managed according to a standard that considers only hypertension, the kidneys are burdened, and there is a risk of promoting chronic renal failure and further progression of hypertension.

  Accordingly, an object of the present invention is to provide a sphygmomanometer capable of measuring whether or not a blood pressure measurement value is within a reference range according to the degree of decrease in renal function.

  The sphygmomanometer according to the present invention includes a blood pressure measurement unit, an acquisition unit that acquires parameters related to renal function, a derivation unit that derives a reference blood pressure value according to the parameters acquired by the acquisition unit, and a blood pressure measurement unit It has the comparison part which compares the measured blood pressure value with a reference | standard blood pressure value, and the output part which outputs the comparison result by a comparison part, It is characterized by the above-mentioned.

  In the sphygmomanometer according to the present invention, it is preferable that the derivation unit derives a reference blood pressure value of the average blood pressure value, and the comparison unit compares the average blood pressure value obtained from the measurement value by the blood pressure measurement unit with the reference blood pressure value.

  In the sphygmomanometer according to the present invention, the acquisition unit acquires the value of the estimated glomerular filtration rate as a parameter related to the renal function, and the derivation unit corresponds to the value of the estimated glomerular filtration rate acquired by the acquisition unit. It is preferable to derive a reference blood pressure value according to the stage of chronic kidney disease.

  In the sphygmomanometer according to the present invention, it is preferable that the output unit outputs the identifiable value to which one of a plurality of blood pressure categories determined based on the reference blood pressure value the measured value by the blood pressure measuring unit belongs.

  According to the sphygmomanometer of the present invention, it is possible to determine whether or not the blood pressure measurement value is within the reference range according to the degree of decrease in renal function.

1 is a schematic configuration diagram of a blood pressure monitor 10. FIG. 2 is a block diagram of a blood pressure monitor 10. FIG. It is the table | surface which showed the example of the table of the renal function stage which the stage determination part 46 uses. It is the table | surface which showed the example of the table of the reference blood pressure value which the reference blood pressure derivation | leading-out part 47 uses. It is the table | surface which showed the example of the table of the blood pressure classification which the appropriate blood pressure determination part 48 uses. 3 is a flowchart showing an operation example of the sphygmomanometer 10. 6 is a diagram showing a display example of the display unit 21. FIG. 6 is a diagram showing a display example of the display unit 21. FIG.

  Hereinafter, a blood pressure monitor according to the present invention will be described in detail with reference to the accompanying drawings. However, it should be noted that the technical scope of the present invention is not limited to these embodiments, but extends to the invention described in the claims and equivalents thereof.

  This sphygmomanometer is a parameter related to renal function such as the value of serum creatinine and the presence or absence of urine protein included in the results of a health check, or the value of eGFR calculated from them, in addition to the gender and age of the subject. Can be entered. When these parameters are input, this sphygmomanometer determines the stage of renal function decline (stage of chronic kidney disease) of the measurement subject and derives a reference blood pressure value corresponding to the stage. When the blood pressure measurement is performed, the blood pressure monitor determines whether or not the measurement result is included in the reference range set according to the stage of the renal function decrease of the measurement subject, and outputs the determination result. . Thus, by setting the reference range of blood pressure according to the degree of decrease in renal function, this blood pressure monitor enables blood pressure management to prevent chronic renal failure and further acceleration of hypertension. Hereinafter, the stage of renal function decline (stage of chronic kidney disease) is simply referred to as “renal function stage”.

  FIG. 1A and FIG. 1B are schematic configuration diagrams of a sphygmomanometer 10. FIG. 1A shows the overall configuration of the sphygmomanometer 10 as a perspective view, and FIG. 1B shows the internal configuration of the sphygmomanometer 10. FIG. 2 is a block diagram of the sphygmomanometer 10.

  The sphygmomanometer 10 includes a main body 20, a cuff 50, and an air tube 60. The cuff 50 includes an air bag 51 that stores air sent from the main body 20. The cuff 50 is wound around, for example, the upper arm portion of the person to be measured and fixed by the surface fastener 52. 1A shows the cuff 50 in a rolled state, and FIG. 1B shows the cuff 50 in an opened state. The air pipe 60 is a pipe for sending air from the main body 20 to the cuff 50. The air pipe 60 is connected to each part in the main body 20 via the plug 61 and the connector 62, and the opposite end is connected to the cuff 50.

  The main body 20 includes a display unit 21, an operation unit 22, a pressure pump 23, a drive circuit 24, a pressure sensor 25, an oscillation circuit 26, an exhaust valve 27, a drive circuit 28, a memory 30, and a control. Part 40. The pressurizing pump 23, the pressure sensor 25, and the exhaust valve 27 are connected by a cuff 50 and an air pipe 60.

  The display unit 21 is configured by, for example, a liquid crystal display panel, and displays a numerical value being measured, measurement results of the maximum blood pressure value and the minimum blood pressure value, whether the measurement result is within a reference range, and the like. The display unit 21 is an example of an output unit.

  The operation unit 22 includes a switch for instructing start / stop of measurement, a button for inputting parameters of the measurement subject, a determination button, and the like. The sphygmomanometer 10 receives input of parameters of the measurement subject via the operation unit 22. The operation unit 22 is an example of an acquisition unit.

  The pressurizing pump 23 pressurizes the inside of the cuff 50 by sending air into the cuff 50. The drive circuit 24 drives the pressurizing pump 23 based on a control signal given from the control unit 40.

  The pressure sensor 25 is a sensor that detects the pressure in the cuff 50 and converts it into an electrical signal, and outputs a pressure detection signal to the oscillation circuit 26. The pressure in the cuff 50 is the pressure in the air bag provided in the cuff 50. The oscillation circuit 26 converts the pressure detection signal acquired from the pressure sensor 25 into a frequency signal and outputs it to the control unit 40. The pressure in the cuff 50 is calculated from this change in frequency.

  The exhaust valve 27 includes, for example, a rubber slow leak valve that gradually exhausts the air in the cuff 50 at a constant speed during blood pressure measurement, and an electromagnetic valve that forcibly exhausts the air in the cuff 50 when the measurement is completed or stopped. Is done. The drive circuit 28 opens and closes the exhaust valve 27 based on a control signal given from the control unit 40.

  The memory 30 stores information necessary for the operation of the sphygmomanometer 10. In particular, the memory 30 stores a table in which the numerical value of eGFR and the renal function stage are associated, a table in which the renal function stage is associated with the reference blood pressure value, and a table in which the reference blood pressure value is associated with the blood pressure classification.

  The control unit 40 is configured as a control circuit including a CPU, RAM, ROM, and the like. The control unit 40 includes, as functional blocks, a pressurization control unit 41, an exhaust control unit 42, a blood pressure value calculation unit 43, an average blood pressure calculation unit 44, an eGFR calculation unit 45, a stage determination unit 46, and a reference blood pressure. A derivation unit 47, an appropriate blood pressure determination unit 48, and a display control unit 49 are included.

  The pressurization control unit 41 controls the drive circuit 24 so as to pressurize the cuff 50 until the pressure detected by the pressure sensor 25 reaches a predetermined pressurization upper limit pressure.

  The exhaust control unit 42 gives a control signal for controlling the opening / closing of the exhaust valve 27 to the drive circuit 28 to control the exhaust of the air in the cuff 50 by the exhaust valve 27.

  The blood pressure value calculation unit 43 measures the blood pressure value of the measurement subject when the cuff 50 is depressurized by the exhaust valve 27 after being pressurized by the pressurizing pump 23 until the cuff pressure reaches the upper limit pressure. To do. The blood pressure value calculation unit 43 uses an oscillometric method, for example, based on data such as the start pressure value of each pulse wave detected from the change in the frequency of the frequency signal generated by the oscillation circuit 26 and the measurement time thereof. The maximum blood pressure value and the minimum blood pressure value of the measurer are calculated. The pressurization pump 23, drive circuit 24, pressure sensor 25, oscillation circuit 26, exhaust valve 27, drive circuit 28, pressurization control unit 41, exhaust control unit 42, and blood pressure value calculation unit 43 are examples of a blood pressure measurement unit. .

The average blood pressure calculation unit 44 calculates the average blood pressure value = minimum blood pressure value + (maximum blood pressure value−minimum blood pressure value) / 3 from the maximum blood pressure value and the minimum blood pressure value calculated by the blood pressure value calculation unit 43. 1)
The average blood pressure value is calculated according to

The eGFR calculation unit 45 calculates the expression eGFR = 194 × (a ^−1.094 ) × (b ^−0.287 ) × c from the numerical value, age, and sex of the subject's serum creatinine input via the operation unit 22. (2)
According to the above, the numerical value of eGFR is calculated. Here, a is a numerical value of serum creatinine, and b is age. Further, c is a correction coefficient according to gender, which is 1 when the measurement subject is male and 0.739 when the measurement subject is female.

  The stage determination unit 46 determines the renal function stage of the measurement subject by referring to a table stored in the memory 30 based on the numerical value of eGFR calculated by the eGFR calculation unit 45.

  FIG. 3 is a table showing an example of a renal function stage table used by the stage determination unit 46. The table in FIG. 3 correlates numerical values of eGFR and renal function stages according to the chronic kidney disease stage classification determined by the Japanese Society of Nephrology. Here, for convenience, even when the renal function is normal, it is classified into stage (stage) 1. When the value of eGFR is 90 or more, it is stage 1 and corresponds to a state in which the renal function is normal or there is an initial renal disorder. From this point, as the value of eGFR decreases from 60 to less than 90, from 30 to less than 60, and from 15 to less than 30, it corresponds to the stage 2, 3, and 4 in which chronic kidney disease has progressed more. Moreover, when the numerical value of eGFR is less than 15, it is stage 5, corresponding to a state in which artificial dialysis is necessary due to renal failure. The memory 30 stores a data table as shown in FIG. 3, for example, and the stage determination unit 46 refers to this data table, for example, and determines the renal function stage of the measurement subject from the value of eGFR calculated by the eGFR calculation unit 45. Determine.

  The reference blood pressure deriving unit 47 refers to the table stored in the memory 30 based on the renal function stage of the measured person determined by the stage determining unit 46, and thereby according to the renal function stage of the measured person. A reference blood pressure value is derived. The stage determination unit 46 and the reference blood pressure deriving unit 47 are an example of a deriving unit that derives a reference blood pressure value.

  FIG. 4 is a table showing an example of a reference blood pressure value table used by the reference blood pressure deriving unit 47. Here, the average blood pressure value is used as the reference blood pressure value. Patterns A, B, and C are labels attached to the reference blood pressure value. In order to avoid high blood pressure, it is desirable to manage blood pressure lower as the degree of decrease in renal function is greater. For this reason, as shown in FIG. 4, the reference blood pressure value decreases as the renal function stage progresses.

  In addition, it is known that the presence of urine protein places a burden on the kidneys. Therefore, the classification of the subject's urine protein input via the operation unit 22 is “−” (without urine protein), or “+” (with urine protein) or “±” (presence / absence of urine protein) Different reference blood pressure values are set depending on whether or not the state is indistinguishable. Note that “+” and “±” are not distinguished from each other because they are put together as a case where there is a possibility that the kidney is burdened. The memory 30 stores, for example, a data table as shown in FIG. 4, and the reference blood pressure deriving unit 47 refers to this data table, for example, the renal function stage and operation unit of the measurement subject determined by the stage determining unit 46 The reference blood pressure value of the person to be measured is derived from the classification of the urine protein of the person to be measured that is input via 22.

  The appropriate blood pressure determination unit 48 compares the average blood pressure value of the measurement subject calculated by the average blood pressure calculation unit 44 with the reference blood pressure value derived by the reference blood pressure deriving unit 47. Then, the appropriate blood pressure determination unit 48 determines which of the plurality of blood pressure categories set according to the reference blood pressure value the average blood pressure value of the measurement subject as the measurement result belongs to. That is, the appropriate blood pressure determination unit 48 determines whether or not the average blood pressure value is within a reference range that is set according to the stage of renal function reduction of the measurement subject. The appropriate blood pressure determination unit 48 is an example of a comparison unit that compares a measured blood pressure value with a reference blood pressure value.

  FIG. 5 is a table showing an example of a blood pressure classification table used by the appropriate blood pressure determination unit 48. Patterns A, B, and C correspond to the cases of the reference blood pressure values 106.7 mmHg, 100.0 mmHg, and 91.6 mmHg, respectively, in FIG. For example, pattern A is a “within reference range” blood pressure category in which the average blood pressure value is less than the reference blood pressure value of 106.7 mmHg. When the average blood pressure value is 106.7 mmHg or more and less than 120.0 mmHg or more than 120.0 mmHg, the blood pressure classification is “high” or “very high”, respectively. The display colors “red”, “blue”, and “yellow” are colors when the determination result by the appropriate blood pressure determination unit 48 is displayed on the display unit 21. The ranges of the blood pressure classifications “within the reference range”, “high”, and “very high” are different in the patterns A, B, and C, and are set according to the reference blood pressure value. The memory 30 stores, for example, a data table as shown in FIG. 5, and the appropriate blood pressure determination unit 48 refers to this data table, for example, to select the blood pressure classification corresponding to the reference blood pressure value derived by the reference blood pressure deriving unit 47. get. Then, the appropriate blood pressure determination unit 48 determines to which of these blood pressure categories the average blood pressure value of the measurement subject belongs.

  The display control unit 49 causes the display unit 21 to display the highest and lowest blood pressure values measured by the blood pressure value calculation unit 43. Further, the display control unit 49 may cause the display unit 21 to display a message for notifying the user whether or not the measurement result is within the reference range.

  FIG. 6 is a flowchart showing an operation example of the sphygmomanometer 10. FIGS. 7A to 7D and FIGS. 8A to 8D are diagrams showing display examples of the display unit 21. FIG. The processing flow shown in FIG. 6 is executed by the CPU of the control unit 40 in accordance with a program recorded in advance in the ROM of the control unit 40.

  First, when the power is turned on, the sphygmomanometer 10 accepts input of the value of serum creatinine, the presence / absence of urine protein, sex and age via the operation unit 22 (S1). For example, when the eGFR button 221 of the operation unit 22 is pressed, the sphygmomanometer 10 enters the eGFR calculation mode.

  As shown in FIG. 7A, the sphygmomanometer 10 first causes the age mark 211 to blink on the display unit 21 and prompts the user to input the age of the subject. For example, the user operates the up button 222 or the down button 223 to display the age of the person to be measured by increasing or decreasing the number, and presses the enter button 224 to input the age.

  Next, as shown in FIG. 7B, the sphygmomanometer 10 causes the sex mark 212 to blink on the display unit 21, for example, and prompts the subject to input the sex. For example, the user operates the up button 222 or the down button 223 to select “male” or “female”, and presses the enter button 224 to input gender.

  Next, as shown in FIG. 7C, the sphygmomanometer 10 causes the CRE mark 213 to blink on the display unit 21 and input the value of the serum creatinine of the measurement subject. For example, the user operates the up button 222 or the down button 223 to display the numerical value of the subject's serum creatinine by increasing or decreasing the numerical value, and presses the enter button 224 to input the numerical value.

  Next, as shown in FIG. 7D, the sphygmomanometer 10 causes the urine protein mark 214 to blink on the display unit 21 and input the presence or absence of the urine protein of the measurement subject. For example, the user operates the up button 222 or the down button 223 to select “−” or “+ ±”, and presses the enter button 224 to input the presence or absence of urine protein.

  Subsequently, the eGFR calculation unit 45 calculates the value of eGFR according to the above equation (2) from the value, age, and sex of the serum creatinine of the measurement subject input in step S1 (S2). Furthermore, the stage determination unit 46 determines the renal function stage corresponding to the numerical value of eGFR calculated in step S2 by referring to the table of FIG. 3 stored in the memory 30 (S3).

At this time, as shown in FIG. 8A, the numerical value of eGFR and the renal function stage obtained in steps S2 and S3 are blinked on the display unit 21, for example. In the example shown in FIG. 7 (A) to FIG. 7 (C), the age is 52 years old, male, and serum creatinine 2.0. Therefore, the eGFR calculation unit 45 is represented by the equation (2):
eGFR = 194 × (2.0 ^−1.094 ) × (52 ^−0.287 ) × 1 = 29.24
And calculate. Since this value is 15 or more and less than 30, the stage determination unit 46 determines that it is stage 4. Thereby, the display control unit 49 displays “29.2” and “G4” on the display unit 21, for example. For example, when the user presses the enter button 224, the display control unit 49 deletes these displays.

  Next, the reference blood pressure deriving unit 47 derives a reference blood pressure value corresponding to the renal function stage determined in step S3 by referring to the table of FIG. 4 stored in the memory 30 (S4). For example, when the renal function stage of the measurement subject is stage 4, the reference blood pressure value is 91.6 mmHg of pattern C.

  Here, when the user presses the measurement button 225, the blood pressure value calculation unit 43 measures the blood pressure of the measurement subject (S5). At this time, the pressurization control unit 41 controls the pressurization pump 23 to pressurize the inside of the cuff 50 to a predetermined pressurization upper limit pressure, and the exhaust control unit 42 opens the exhaust valve 27 to depressurize the cuff 50. Meanwhile, the blood pressure value calculation unit 43 calculates the highest blood pressure value and the lowest blood pressure value of the measurement subject. Further, the average blood pressure calculation unit 44 calculates the average blood pressure value from the equation (1) using the maximum blood pressure value and the minimum blood pressure value calculated in step S5 (S6).

  Subsequently, the appropriate blood pressure determination unit 48 refers to the table of FIG. 5 stored in the memory 30 to obtain a blood pressure category corresponding to the reference blood pressure value derived in step S4, and is calculated in step S6. It is determined whether the average blood pressure value is within the reference range according to the blood pressure category (S7). For example, when the renal function stage of the measurement subject is stage 4, since the reference blood pressure value is 91.6 mmHg of pattern C, the average blood pressure value is less than 91.6 mmHg, 91.6 mmHg or more and 100.0 mmHg from FIG. Less than, 100.0 mmHg or more, blood pressure categories of “within reference range”, “high”, and “very high” are applied, respectively. Then, the display control unit 49 displays the maximum blood pressure value and the minimum blood pressure value, which are the measurement values calculated in step S5, and the determination result in step S7 on the display unit 21 (S8).

For example, as shown in FIG. 8B, assuming that the maximum blood pressure value calculated in step S5 is 138 mmHg and the minimum blood pressure value is 100 mmHg, in step S6, the average blood pressure value = 100 + (138 −100) / 3 = 112 mmHg
Is calculated. When the renal function stage of the measurement subject is stage 4, since 112 mmHg belongs to the “very high” blood pressure category of 100.0 mmHg or more, the display unit 21 shows “very high” in step S8. A “red” mark 215 is lit.

Further, as shown in FIG. 8C, when the maximum blood pressure value calculated in step S5 is 125 mmHg and the minimum blood pressure value is 80 mmHg, in step S6, the average blood pressure value = 80 + (125 −80) / 3 = 95 mmHg
Is calculated. When the renal function stage of the measurement subject is stage 4, since 95 mmHg belongs to the “high” blood pressure category of 91.6 mmHg or more and less than 100.0 mmHg, “high” is displayed on the display unit 21 in step S8. A “yellow” mark 216 is lit.

Further, as shown in FIG. 8D, when the maximum blood pressure value calculated in step S5 is 120 mmHg and the minimum blood pressure value is 73 mmHg, in step S6, the average blood pressure value = 73 + (120 -73) / 3 = 89 mmHg
Is calculated. When the renal function stage of the measurement subject is stage 4, since 89 mmHg belongs to the “within reference range” blood pressure category of less than 91.6 mmHg, the display unit 21 indicates “within reference range” in step S8. A “blue” mark 217 is lit.

  Thus, the sphygmomanometer 10 ends the operation.

  The sphygmomanometer 10 includes an eGFR calculation unit 45 that calculates an eGFR value, but the eGFR value included in the health check result may be directly input by the operation unit 22. In this case, the function of the eGFR calculation unit 45 becomes unnecessary. Further, the measurement result of the maximum blood pressure value and the minimum blood pressure value by the blood pressure value calculation unit 43 and the determination result of the blood pressure classification by the appropriate blood pressure determination unit 48 are output to other devices such as a user's portable terminal for use. A person may be able to check them with another device.

  As described above, the sphygmomanometer 10 determines whether or not the measurement result of the blood pressure value is within the reference range set according to the stage of decrease in renal function of the measurement subject, and outputs the determination result. To do. Thus, by setting the reference range of blood pressure according to the degree of decrease in renal function, this sphygmomanometer can perform blood pressure management to prevent chronic renal failure and further acceleration of hypertension.

DESCRIPTION OF SYMBOLS 10 Blood pressure monitor 20 Main body 21 Display part 22 Operation part 30 Memory 40 Control part 43 Blood pressure value calculation part 44 Average blood pressure calculation part 45 eGFR calculation part 46 Stage determination part 47 Reference blood pressure derivation part 48 Appropriate blood pressure determination part 50 Cuff

Claims (4)

A blood pressure measurement unit;
An acquisition unit for acquiring parameters related to renal function;
A derivation unit for deriving a reference blood pressure value according to the parameter acquired by the acquisition unit;
A comparison unit that compares the blood pressure value measured by the blood pressure measurement unit with the reference blood pressure value;
An output unit for outputting a comparison result by the comparison unit;
A sphygmomanometer, comprising: The derivation unit derives a reference blood pressure value of an average blood pressure value,
The sphygmomanometer according to claim 1, wherein the comparison unit compares an average blood pressure value obtained from a measurement value by the blood pressure measurement unit with the reference blood pressure value. The acquisition unit acquires the value of the estimated glomerular filtration rate as a parameter related to renal function,
The sphygmomanometer according to claim 1, wherein the deriving unit derives a reference blood pressure value corresponding to a stage of chronic kidney disease corresponding to the value of the estimated glomerular filtration rate acquired by the acquiring unit.   4. The output unit according to claim 1, wherein the output unit outputs in a identifiable manner a user belongs to which of a plurality of blood pressure categories determined based on the reference blood pressure value. The blood pressure monitor according to item.

Images