Der Nephrologe

, Volume 1, Issue 3, pp 191–199

Arterielle Hypertonie

Diagnostik sekundärer Hochdruckursachen, kardiovaskuläre Endorganschädigung und leitliniengerechte Therapie
CME Weiterbildung · Zertifizierte Fortbildung
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Zusammenfassung

Die Klassifikation der Hypertonie bezeichnet Grad I (140–159/90–99 mmHg), Grad II (160–179/100–109 mmHg) und Grad III (≥180/≥110 mmHg); Werte zwischen 130/85 und 139/89 mmHg gelten als hochnormal, Werte <120/80 mmHg als optimal.

Die Diagnostik umfasst neben Serumelektrolyten und -kreatinin Parameter zur Einschätzung des kardiovaskulären Risikos (Blutglukose, ggf. oGTT, Lipidstatus, CRP, Mikroalbuminurie), endokrinologische Tests (Hyperaldosteronismus, Hyperkortisolismus, Hyperthyreose), Tests auf renovaskuläre Ursachen und häufige assoziierte Erkrankungen (Schlafapnoe-Syndrom, Diabetes mellitus Typ 2) sowie exogene Noxen oder Medikamente.

Die Wahl der antihypertensiven Therapie basiert einerseits auf der Höhe des systolischen und diastolischen Blutdrucks und andererseits auf der Stratifizierung des kardiovaskulären Gesamtrisikos. Bei Patienten mit Diabetes mellitus sollten die Blutdruckwerte <130/80 mmHg liegen, bei Patienten mit Nierenfunktionseinschränkung <125/75 mmHg.

Schlüsselwörter

Arterielle Hypertonie Kardiovaskuläre Risikostratifizierung Endorganschädigung Leitlinien Zielblutdruck 

Arterial hypertension

Diagnosis of secondary causes of hypertension, cardiovascular end-organ damage and recommended therapy

Abstract

The new classification of hypertension defines grade I (140–159/90–99 mmHg), grade II (160–179/100–109 mmHg) and grade III (≥180/≥110 mmHg). Values between 130/85 and 139/89 mmHg are considered as above normal, values below 120/80 mmHg are considered to be optimal.

Recommended basic diagnostics in hypertension are serum electrolytes and creatinine as well as parameters to assess the global cardiovascular risk (blood glucose, oral glucose tolerance test, lipids, CRP, microalbuminuria). The diagnostic approach for secondary causes of hypertension comprises endocrine tests for hyperaldosteronism, hypercortisolism and hyperthyroidism, tests for renal artery stenosis, examination of associated conditions such as sleep-apnoe syndrome, diabetes as well as exogenous noxious substances or drugs.

The choice of antihypertensive therapy is based on systolic and diastolic blood pressure levels and takes accompanying cardiovascular risk factors into consideration. The targeted blood pressure levels depend on the extent of end-organ damage and individual cardiovascular risk. In patients with diabetes the therapeutic goal is a blood pressure level of ≤130/80 mmHg, in patients with kidney disease the therapeutic objective is ≤125/75 mmHg.

Keywords

Arterial hypertension Cardiovascular risk stratification End-organ damage Guidelines Target blood pressure level 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Abteilung Nephrologie der II. Medizinischen KlinikKlinikum rechts der IsarMünchen

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