Zusammenfassung
Hintergrund
Die arterielle Hypertonie ist immer noch die wesentliche Volkskrankheit in Deutschland. Über 60% der über 60-jährigen Patienten entwickeln einen Bluthochdruck, und die Folgen sind für die Patienten durch Schlaganfall oder auch Herzinfarkt nicht selten sehr dramatisch. In den letzten Jahren gab es zahllose Studien, die den Einfluss der antihypertensiven Therapieoptionen auf Morbidität und Mortalität der Patienten untersucht haben.
Ziel
In dieser sollen die aktuellen Leitlinien zur Hypertonietherapie dargestellt und zusammengefasst werden.
Material/Methoden
Mehrere internationalen Hypertonie-Fachgesellschaften haben in den letzten Jahren überarbeitete Empfehlungen zur rationalen und auch ressourcenschonenden Diagnostik und Therapie der arteriellen Hypertonie vorgelegt. Insbesondere die Zielwerte wie auch die therapeutischen Ansätze wurden überarbeitet. Es gilt für fast alle Patientengruppen der Zielblutruck von unter 140/90 mmHg. Bei älteren Patienten über dem 80. Lebensjahr wird ein Blutdruck bis 150 mmHg systolisch toleriert. In der Therapie wird bei komplizierten Hypertonieformen eine frühe antihypertensive Kombinationstherapie empfohlen. Besonderen Stellenwert in der antihypertensiven First-line-Therapie haben ACE-Hemmer bzw. Angiotensinrezeptorblocker, Kalziumantagonisten oder auch Thizaiddiruetika.
Diskussion
Die zum Teil sehr ambitionierten Empfehlungen zur Blutdrucktherapie vom Beginn des Jahrhunderts wurden in aktuellen Therapieleitlinien erheblich gelockert. Vor allem eine Kombinationstherapie verschiedener Antihypertensiva rückt zunehmend in den Vordergrund der Therapieoptionen.
Abstract
Background
Hypertension is still one of the most important diseases in Germany. More than 60% of patients over 60 years of age suffer from hypertension. The consequences of uncontrolled hypertension are stroke or ischemic heart disease. Many studies during the last decades investigated therapeutic options to lower hypertension with respect to morbidity and mortality.
Aim
In this review, a summary of recently published guidelines to diagnose and treat hypertension is given.
Material and methods
Several international hypertension societies and groups have revised their guidelines for rational and also resource sparing diagnostics and therapy of arterial hypertension during recent years. The target values and therapeutic approaches in particular were amended.
Results
Target values for treatment of hypertension were changed in current guidelines. The treatment goal for all hypertensive patients is now below 140/90 mmHg. Patients older than 80 years of age might have systolic blood pressure up to 150 mmHg without intensification of therapy. Early combination of blood pressure reducing agents is applicable in many patients. For first line antihypertension therapy special importance is given to angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, calcium antagonists and thiazide diuretics.
Discussion
In the new guidelines there is a special focus on blood pressure values which are not so ambitious as in the early phase of this century. Blood pressure goals are now more moderate. Combination therapy is now generally accepted for many patients in eary stages, to target the correct blood pressure control.
Literatur
Mancia G, De Backer G, Dominiczak A et al (2007) 2007 guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187
Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34:2159–2219
Mancia G, Laurent S, Agabiti-Rosei E et al (2009) Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 27:2121–2158
Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 31:1925–1938
Weber MA, Schiffrin EL, White WB et al (2014) Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens 32:3–15
James PA, Oparil S, Carter BL et al (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311:507–520
O’Brien E, Parati G, Stergiou G et al (2013) European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens 31:1731–1768
O’Rourke MF, Adji A (2013) Guidelines on guidelines: focus on isolated systolic hypertension in youth. J Hypertens 31:649–654
Appel LJ, Wright JT Jr, Greene T et al (2010) Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med 363:918–929
Upadhyay A, Earley A, Haynes SM, Uhlig K (2011) Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med 154:541–548
Czernichow S, Zanchetti A, Turnbull F et al (2011) The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta-analysis of randomized trials. J Hypertens 29:4–16
Hansson L, Zanchetti A, Carruthers SG et al (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351:1755–1762
Zanchetti A (2010) Blood pressure targets of antihypertensive treatment: up and down the J-shaped curve. Eur Heart J 31:2837–2840
ACCORD Study Group, Cushman WC, Evans GW et al (2010) Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 362:1575–1585
Wiysonge CS, Bradley HA, Volmink J et al (2012) Beta-blockers for hypertension. Cochrane Database Syst Rev 11:CD002003
ONTARGET Investigators, Yusuf S, Teo KK et al (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358:1547–1559
Mann JF, Schmieder RE, McQueen M et al (2008) Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 372:547–553
Parving HH, Brenner BM, McMurray JJ et al (2012) Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 367:2204–2213
Jamerson K, Weber MA, Bakris GL et al (2008) Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 359:2417–2428
Jung O, Gechter JL, Wunder C et al (2013) Resistant hypertension? Assessment of adherence by toxicological urine analysis. J Hypertens 31:766–774
Vaclavik J, Sedlák R, Plachy M et al (2011) Addition of spironolactone in patients with resistant arterial hypertension (ASPIRANT): a randomized, double-blind, placebo-controlled trial. Hypertension 57:1069–1075
Roush GC, Holford TR, Guddati AK (2012) Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta-analyses. Hypertension 59:1110–1117
Schmieder RE, Redon J, Grassi G et al (2013) Updated ESH position paper on interventional therapy of resistant hypertension. EuroIntervention 9(Suppl R):R58–R66
Einhaltung ethischer Richtlinien
Interessenkonflikt. M. van der Giet und W. Zidek geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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van der Giet, M., Zidek, W. Hypertonie-Update 2014. Nephrologe 9, 364–372 (2014). https://doi.org/10.1007/s11560-014-0872-2
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DOI: https://doi.org/10.1007/s11560-014-0872-2