Der Internist

, Volume 50, Issue 4, pp 423–432

Schlaganfall und Hypertonie

Schwerpunkt: Hypertonie

Zusammenfassung

Die arterielle Hypertonie ist der wichtigste Risikofaktor für den Schlaganfall. Der Nutzen einer antihypertensiven Therapie ist durch viele Interventionsstudien für die Primär- und auch für die Sekundärprävention für alle Altersgruppen eindeutig belegt. Eine Empfehlung einer hypertensiven Substanz speziell für die Primärprävention des Schlaganfalls gibt es nicht. Um das Therapieziel (Normotonie) zu erreichen, sind meist antihypertensive Mehrfachkombinationen erforderlich. Bei Hochrisikopatienten sowie in der Sekundärprävention sind möglicherweise Hemmstoffe des Renin-Angiotensin-Systems besonders in Kombination mit Kalziumantagonisten und Indapamid vorteilhaft. β-Blocker erscheinen weniger geeignet. Bei Patienten mit linksventrikulärer Hypertrophie oder Vorhofflimmern sind Sartane am besten belegt. Zur Therapiekontrolle sollte auch die ambulante 24-h-Blutdruckmessung eingesetzt werden, da häufig eine gestörte Blutdruckrhythmik mit fehlender nächtlicher Blutdrucksenkung vorliegt, die für die Prognose von erheblicher Bedeutung ist. Der Zusammenhang zwischen vaskulärer Demenz und Hypertonie gilt inzwischen ebenfalls als gesichert. Eine frühzeitige antihypertensive Therapie kann einer Demenzentwicklung und der Einschränkung kognitiver Funktionen vorbeugen.

Schlüsselwörter

Hypertonie Antihypertensive Therapie Schlaganfall Prävention Demenz 

Stroke and hypertension

Abstract

Arterial hypertension is the most important risk factor for stroke. Many interventional trials have unambiguously proven the benefit of antihypertensive therapy in both primary and secondary prevention for all age categories. No recommendation for any single antihypertensive substance for the primary prevention of stroke exists. Achieving the therapeutic goal (normotension) is the crucial factor. In most patients, multiple combinations of antihypertensive drugs are required to do this. For high-risk patients and in secondary prevention, substances inhibiting the renin-angiotensin-system, especially combined with calcium antagonists and indapamid, may be advantageous, while beta-blockers appear to be less well suited. In patients suffering from left-ventricular hypertrophy or atrial fibrillation, sartanes are the best-documented drug class. As TIA or stroke will often disturb the normal circadian rhythm of blood pressure and eliminate the usual night-time drop, monitoring of the therapeutic results must include ambulatory 24h measurements. The interrelation between vascular dementia and hypertension is by now also considered proven. An early start of antihypertensive treatment can prevent the development of dementia and impaired cognitive function.

Keywords

Hypertension Antihypertensive therapy Stroke Prevention Dementia 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Medizinische KlinikSt.-Josefs-HospitalCloppenburgDeutschland

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