Zusammenfassung
Rund 10% aller Patienten mit arterieller Hypertonie, die medikamentös antihypertensiv behandelt werden, können als „schwer einstellbar“ bzw. „therapieresistent“ eingestuft werden. Eine Therapieresistenz liegt definitionsgemäß vor, wenn trotz einer dreifachen antihypertensiven Medikation inkl. eines Diuretikums Zielblutdruckwerte unter 140/90 mm Hg nicht erreicht werden. Patienten mit therapieresistenter Hypertonie tragen ein hohes Risiko für Hypertoniefolgeerkrankungen, besonders bei Vorliegen zusätzlicher kardiovaskulärer Risikofaktoren wie Diabetes mellitus, Hyperlipidämie und Nikotinkonsum. Die Genese einer schwer einstellbaren Hypertonie ist oft multifaktoriell. Häufig trägt eine nicht sachgemäß durchgeführte Blutdruckmessung zu falsch hohen Blutdruckwerten bei. Non-Compliance in Bezug auf die Einnahme der verordneten Antihypertensiva scheint bei etwa jedem fünften Betroffenen die Hauptursache der Therapieresistenz zu sein. Bei rund 10% der Patienten mit therapieresistenter Hypertonie liegt eine bisher unbehandelte, unvermutete bzw. neu hinzugetretene sekundäre Hypertonieform vor. Das Ziel der Therapie ist die Normalisierung des Blutdrucks, die oft einen multifaktoriellen Ansatz erforderlich macht. Einer optimalen Dosierung der verordneten Antihypertensiva kommt dabei besondere Bedeutung zu. Neuere invasive Verfahren (z. B. renale Denervation) ergänzen das therapeutische Arsenal bei therapieresistenter Hypertonie, wobei aus heutiger Sicht wegen der fehlenden Langzeitergebnisse eine abschließende Bewertung dieser Ansätze noch nicht erfolgen kann.
Abstract
Criteria for hard-to-control or resistant hypertension are met by about 10 % of the antihypertensive drug treated population. Resistant hypertension is defined as failure to lower blood pressure below 140/90 mmHg with triple antihypertensive medication including a diuretic. Patients with resistant hypertension are at high risk for the development of hypertensive end-organ damage, particularly in patients with diabetes, lipid disorders and smokers. Causes include cuff-related artefacts, non-adherence to treatment (about 20 % of cases) and secondary forms of hypertension (about 10 % of cases). The aim of treatment is normalization of blood pressure often by a multifactorial approach. An optimized dosing regimen of antihypertensive drugs is crucial. Newer device-based forms of therapy (e.g. renal sympathetic denervation) are promising but are awaiting further clinical and risk profile substantiation.
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Lenz, T., Hoyer, J. Diagnostik und Therapie bei therapieresistenter Hypertonie. Nephrologe 8, 79–92 (2013). https://doi.org/10.1007/s11560-011-0615-6
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DOI: https://doi.org/10.1007/s11560-011-0615-6