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Antihypertensive Therapie im Alter

Antihypertensive therapy in the elderly

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Zusammenfassung

Eine arterielle Hypertonie ist der häufigste modifizierbare Risikofaktor für die zerebro- und kardiovaskuläre Morbidität und Mortalität im Alter. Auch die Verhinderung kognitiver Hirnleistungsstörungen ist Therapieziel der langfristigen antihypertensiven Therapie. Ältere Patienten haben zudem ein höheres vaskuläres Gesamtrisikoprofil und profitieren deshalb schon von einer relativ moderaten Blutdrucksenkung. Mit Blick auf die hohe Prävalenz der Hypertonie im Alter und der steigenden Inzidenz über die Zeit wird der Therapie der Hypertonie in der wachsenden älteren Bevölkerung eine enorme Bedeutung für eine verbesserte Prognose der Patienten und für eine Reduktion der Kosten zukommen. Die exakte Blutdruckmessung für ältere Patienten umfasst wiederholte Messungen im Sitzen und im Stehen, Selbstmessungen oder Blutdruckmessungen durch Angehörige. Auch hier ist die 24-h-Blutdruckmessung (ABDM) die genaueste Methode zur Beurteilung des alltäglichen Blutdruckniveaus (Praxishypertonie, „non-dipping“, intermittierende Hypotonien). Auch bei älteren Hypertonikern sind Allgemeinmaßnahmen bzw. Lebensstiländerungen zur Blutdrucksenkung wirksam; am besten belegt ist eine salzreduzierte Kost. Für die medikamentöse Therapie werden die gleichen Antihypertensiva wie im jüngeren Lebensalter (bevorzugt Diuretika, RAAS[Renin-Angiotensin-Aldosteron-System]-Hemmer, Kalziumantagonisten) empfohlen. Der Zielblutdruckwert bei älteren Patienten wird immer wieder intensiv diskutiert. Die derzeitigen Empfehlungen und die zu beachtenden Besonderheiten in der Therapie des älteren Patienten werden ausführlich dargelegt.

Abstract

Arterial hypertension is the most common modifiable risk factor for cerebrovascular and cardiovascular morbidity and mortality in old age. The prevention of cognitive brain disorders is also a therapeutic goal of long-term treatment of hypertension. Older patients also have a higher risk of developing cardiovascular diseases and therefore benefit from a relatively moderate reduction in blood pressure. With respect to the high prevalence of hypertension in old age and the increasing incidence with time, the therapy of hypertension is becoming increasingly more important to achieve an improved prognosis for patients along with a reduction of costs. The accurate blood pressure measurement for elderly patients includes repeated measurements while standing and sitting. Additionally, the measurements should also be conducted by the patient or by a family member. The most accurate method for assessing the daily blood pressure level, e.g. practice hypertension, non-dipping and intermittent hypertension, is the 24-h blood pressure measurement by ambulatory blood pressure monitoring (ABPM). General measures and lifestyle interventions are effective for reducing blood pressure of elderly patients with hypertension and a low salt diet is scientifically proven to be superior. The same drugs used for young people are also recommended for older patients and most give preference to diuretics, renin-angiotensin-aldosterone system (RAAS) inhibitors and calcium antagonists. The target blood pressure in elderly patients is repeatedly the focus of scientific discussions. The current recommendations are presented in the text and the characteristics which must be particularly considered in the therapy of elderly patients are presented in detail.

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  1. Medizinische Klinik, St.-Josefs-Hospital Cloppenburg, Krankenhausstr. 13, 49661, Cloppenburg, Deutschland

    J. Schrader & B. Schrader

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J. Schrader und B. Schrader geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schrader, J., Schrader, B. Antihypertensive Therapie im Alter. Herz 43, 197–206 (2018). https://doi.org/10.1007/s00059-017-4642-6

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