Der Nephrologe

, Volume 9, Issue 5, pp 364–372

Hypertonie-Update 2014

Neue Leitlinien kritisch betrachtet
Leitthema
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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.

Schlüsselwörter

Bluthochdruck Therapieempfehlungen Behandlung Resistente Hypertonie Blutdruckzielwerte 

Hypertension update 2014

Critical consideration of new guidelines

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.

Keywords

High blood pressure Standards Treatment Resistant hypertension Blood pressure target values 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Med. Klinik mit SP NephrologieCharité – Universitätsmedizin Berlin, Campus Benjamin FranklinBerlinDeutschland

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