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Isolierte systolische Hypertonie

Ein eigenständiges Krankheitsbild

Isolated systolic hypertension

An independent disease

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Zusammenfassung

In epidemiologischen Studien konnte gezeigt werden, dass nur der systolische Blutdruck im Altersverlauf zunimmt, der diastolische dagegen zwischen dem 55. und 60. Lebensjahr sein Maximum erreicht und danach abfällt. Diese Entwicklung führt dazu, dass die isoliert systolische Hypertonie (ISH) im Alter die vorherrschende Hypertonieform ist. Dabei nimmt bei einem gegebenen systolischen Druck die kardiovaskuläre Komplikationsrate mit sinkendem diastolischem und damit steigendem Pulsdruck (SBD minus DBD) zu. Durch die zunehmende Gefäßsteifigkeit der Arterien kommt es zu einem Anstieg der Pulswellengeschwindigkeit (PWV), zu verstärkten und frühzeitigeren Pulswellenreflexionen sowie zum Anstieg des zentral-aortalen Blutdrucks. Dabei entwickelt sich die ISH entweder neu, bevorzugt aus der Gruppe mit primär hochnormalem Blutdruck oder durch Ausbrennen einer systolisch-diastolischen Hypertonie. Generell führt die Senkung erhöhter Blutdruckwerte nachweislich in jedem Alter zu einer Lebensverlängerung – mit Zielwerten systolisch <140 mmHg und bei über 80-Jährigen <150 mmHg. Da in allen Interventionsstudien die ISH die geringste Rate blutdrucknormalisierter Patienten aufweist, ist i. d. R. eine antihypertensive Kombinationstherapie notwendig – mit der bisher besten Studienevidenz für ACE-Hemmer plus Kalziumantagonisten (bzw. Diuretika).

Abstract

Hypertension can be classified based on certain criteria, such as severity, existence of specific end-organ damage, or the dominant blood pressure subphenotype so that isolated diastolic hypertension (IDH), mixed systolic-diastolic hypertension (SDH), and isolated systolic hypertensive (ISH) states can be defined. The FRAMINGHAM study was the first to demonstrate a continuous increase of systolic blood pressure with age and a peak of diastolic pressure between 55 and 65 years of age. This results not only in a high prevalence of hypertension of approximately 50–80% beyond the age of 60 but also in a disproportionately high increase in isolated systolic hypertension. ISH develops either as a new condition mostly from the group of primary high-normal blood pressure or secondly through burnout of existing systolic-diastolic hypertension with highly progressive vascular ageing.

The pathophysiological background lies in remodeling processes in the macrovascular and microvascular compartments with stiffening of conduit and peripheral arterial vessels. In clinical practice these processes are easy to measure by determining pulse wave velocity (PWV), the augmentation index, and pulse pressure. These parameters are closely related to cardiovascular and cerebrovascular morbidity and mortality

ISH is not only a hypertension subphenotype but often indicates significant organ damage or may even be considered to be a secondary form of hypertension characterized by remodeled and stiffened arterial vessel walls and this condition is difficult to treat. It appears therefore that ISH warrants special therapeutic strategies with a focus on antiproliferative, antistiffening, anti-atherosclerotic, and vasodilating actions. As a result of the available data from the results of treatment studies it appears that renin-angiotensin system (RAS) blockers and calcium channel blockers (CCBs) are the preferred drugs for treatment of this condition.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor hat Vorträge zur ISH gehalten, die von verschiedensten Pharmafirmen gesponsert wurden.

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  1. Medizinische Poliklinik, Charité Universitätsmedizin Berlin, Luisenstr. 11–13, 10117, Berlin, Deutschland

    J. Scholze

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Scholze, J. Isolierte systolische Hypertonie. Herz 35, 568–575 (2010). https://doi.org/10.1007/s00059-010-3390-7

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  • DOI: https://doi.org/10.1007/s00059-010-3390-7

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