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Bedeutung des zentralen und des peripheren Blutdrucks für die Einstellung der arteriellen Hypertonie

Importance of central and peripheral blood pressure for adjustment of arterial hypertension

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Zusammenfassung

Die arterielle Hypertonie ist die häufigste internistische Erkrankung der erwachsenen Bevölkerung in den westlichen Industrieländern. Traditionell erfolgt die Messung des Blutdrucks mittels einer Manschette an der oberen Extremität. Zunehmend wird die klinische Bedeutung des zentralen Blutdrucks erkannt. Im Vergleich zum peripher gemessenen Blutdruck besitzt der zentrale Blutdruck eine deutlich höhere prädiktive Wertigkeit im Hinblick auf das Auftreten kardiovaskulärer Ereignisse. Darüber hinaus ist der Effekt von Antihypertensiva auf den zentralen Blutdruck unterschiedlich – ein Effekt, der wahrscheinlich für die Unterschiede zwischen den Antihypertensiva hinsichtlich ihres Einflusses auf die kardiovaskuläre Mortalität verantwortlich ist. Inzwischen stehen neuartige Messmethoden zur Verfügung, die die einfache, nicht-invasive Bestimmung des zentralen Blutdrucks erlauben. In dieser Übersicht wird die physiologische und pathophysiologische Bedeutung des zentralen Blutdrucks bei der arteriellen Hypertonie dargestellt. Nicht-invasive Techniken zur Messung des zentralen Blutdrucks werden erläutert, und der prädiktive Wert dieser Parameter für das kardiovaskuläre Risiko wird diskutiert.

Abstract

Hypertension is one of the most frequent cardiovascular diseases in industrial countries. Traditionally blood pressure measurements are obtained using pressure cuffs from the upper limbs. There is increasing evidence supporting the clinical value of the central blood pressure. In comparison to peripheral blood pressure, central blood pressure more strongly predicts future cardiovascular events. In addition, antihypertensive treatment lowers peripheral and central blood pressure differently. This effect may contribute to the distinct effects on cardiovascular mortality observed between different antihypertensive drugs. Increasingly, commercially available devices are in use for non-invasive measurement of central hemodynamic parameters. In the present overview the physiological and pathophysiological role of central blood pressure in hypertension is summarized. Non-invasive techniques are illustrated and the predictive value of central blood pressure in hypertension is discussed.

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  1. Klinik für Nephrologie, Helios Kliniken Schwerin, Wismarsche Str. 393–397, 19049, Schwerin, Deutschland

    J. Nürnberger

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Nürnberger, J. Bedeutung des zentralen und des peripheren Blutdrucks für die Einstellung der arteriellen Hypertonie. Herz 37, 735–741 (2012). https://doi.org/10.1007/s00059-012-3686-x

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