Skip to main content
SpringerLink
Log in

Neue ESH/ESC-Leitlinien für die arterielle Hypertonie

Was ist neu, und welche Indikation bleibt für die renale Denervierung?

New ESH/ESC guidelines on arterial hypertension

What is new and what indications remain for renal denervation?

  • Schwerpunkt
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Die arterielle Hypertonie ist eine der häufigsten Erkrankungen in der westlichen Welt und einer der wichtigsten Risikofaktoren für andere kardiovaskuläre Krankheiten. Trotz breiter therapeutischer Möglichkeiten liegt immer noch die Mehrzahl der Patienten mit den Blutdruckwerten über dem Zielkorridor. Die neuen europäischen Leitlinien zur Hypertonie geben hier eine klare Handlungslinie zur Diagnostik und Therapie auch auf dem Boden von Evidenzgraden anhand der aktuellen wissenschaftlichen Datenlage. Diese ist für die renale Denervation noch unklar. Hier kann noch keine eindeutige Empfehlung ausgesprochen werden.

Abstract

Arterial hypertension is one of the most common diseases in the western world and one of the most important risk factors for other cardiovascular diseases. Despite widespread therapeutic options, there is still a large proportion of patients with uncontrolled hypertension. The new European guidelines on hypertension give clear lines of action for diagnosis and treatment sorted into appropriate evidence levels based on current scientific data. Such evidence is still unclear for renal denervation so that no clear recommendations can be given.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Fink W, Haidinger G (2007) Die Häufigkeit von Gesundheitsstörungen in 10 Jahren Allgemeinpraxis. Z Allg Med 83(200):102–108. Zitiert nach „Womit sich Hausärzte hauptsächlich beschäftigen“, MMW Fortschr Med Nr. 16/2007 (149. Jg.)

    Article  Google Scholar 

  2. Wilson PW (1994) Established risk factors and coronary artery disease: the Framingham Study. Am J Hypertens 7(7 Pt 2):7S–12S

    CAS  PubMed  Google Scholar 

  3. Levy D, Larson MG, Vasan RS et al (1996) The progression from hypertension to congestive heart failure. JAMA 275(20):1557–1562

    Article  CAS  PubMed  Google Scholar 

  4. Janhsen K, Strube H, Starker A (2008) Hypertonie. Gesundheitsberichterstattung des Bundes 43:1–35

    Google Scholar 

  5. Diederichs C, Neuhauser H (2014) Regional variations in hypertension prevalence and management in Germany: results from the German Health Interview and Examination Survey (DEGS1). J Hypertens 32(7):1405–1413

    Article  CAS  PubMed  Google Scholar 

  6. Lorell BH, Carabello BA (2000) Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 102(4):470–479

    Article  CAS  PubMed  Google Scholar 

  7. Vakili BA, Okin PM, Devereux RB (2001) Prognostic implications of left ventricular hypertrophy. Am Heart J 141(3):334–341

    Article  CAS  PubMed  Google Scholar 

  8. Staessen JA, Fagard R, Thijs L et al (1997) Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 350(9080):757–764

    Article  CAS  PubMed  Google Scholar 

  9. Coresh J, Wei GL, McQuillan G et al (2001) Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med 161(9):1207–1216

    Article  CAS  PubMed  Google Scholar 

  10. Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34(28):2159–2219

    Article  PubMed  Google Scholar 

  11. o A (1998)Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 317(7160):703–713

    Article  Google Scholar 

  12. Sarnak MJ, Greene T, Wang X et al (2005) The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med 142(5):342–351

    Article  PubMed  Google Scholar 

  13. Upadhyay A, Earley A, Haynes SM, Uhlig K (2011) Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med 154(8):541–548

    Article  PubMed  Google Scholar 

  14. Sheppard JP, Holder R, Nichols L et al (2014) Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study. J Hypertens 32(11):2171–2178

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Picano E, Pálinkás A, Amyot R (2001) Diagnosis of myocardial ischemia in hypertensive patients. J Hypertens 19(7):1177–1183

    Article  CAS  PubMed  Google Scholar 

  16. Zanchetti A, Hennig M, Hollweck R et al (2009) Baseline values but not treatment-induced changes in carotid intima-media thickness predict incident cardiovascular events in treated hypertensive patients: findings in the European Lacidipine Studyon Atherosclerosis (ELSA). Circulation 120(12):1084–1090

    Article  PubMed  Google Scholar 

  17. Crouch R, Wilson A, Newbury J (2011) A systematic review of the effectiveness of primary health education or intervention programs in improving rural women’s knowledge of heart disease risk factors and changing lifestyle behaviours. Int J Evid Based Healthc 9(3):236–245

    PubMed  Google Scholar 

  18. Schrier RW, Estacio RO, Esler A, Mehler P (2002) Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int 61(3):1086–1097

    Article  PubMed  Google Scholar 

  19. McMurray JJ, Holman RR, Haffner SM et al (2010) Effect of valsartan on the incidence of diabetes and cardiovascular events. N Engl J Med 362(16):1477–1490

    Article  CAS  PubMed  Google Scholar 

  20. Schunkert H (2007) A dream yet to become true. Hypertension 50(1):39–40

    Article  CAS  PubMed  Google Scholar 

  21. Zanchetti A, Grassi G, Mancia G (2009) When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens 27(5):923–934

    Article  CAS  PubMed  Google Scholar 

  22. Roush GC, Holford TR, Guddati AK (2012) Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta-analyses. Hypertension 59(6):1110–1117

    Article  CAS  PubMed  Google Scholar 

  23. ONTARGET Investigators, Yusuf S, Teo KK et al (2008) Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 358(15):1547–1559

    Article  Google Scholar 

  24. Krum H, Schlaich M, Whitbourn R et al (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373(9671):1275–1281

    Article  PubMed  Google Scholar 

  25. Symplicity HTN-2 Investigators, Esler MD, Krum H et al (2010) Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 376(9756):1903–1909

    Article  Google Scholar 

  26. Bhatt DL, Kandzari DE, O’Neill WW et al (2014) A controlled trial of renal denervation for resistant hypertension. N Engl J Med 370(15):1393–1401

    Article  CAS  PubMed  Google Scholar 

  27. Atherton DS, Deep NL, Mendelsohn FO (2012) Micro-anatomy of the renal sympathetic nervous system: a human postmortem histologic study. Clin Anat 25(5):628–633

    Article  PubMed  Google Scholar 

  28. Sakakura K, Ladich E, Cheng Q et al (2014) Anatomic assessment of sympathetic peri-arterial renal nerves in man. J Am Coll Cardiol 64(7):635–643

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Groha, S. Kufner, I. Ott und H. Schunkert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Lazarettstr. 36, 80636, München, Deutschland

    P. Groha, S. Kufner, I. Ott & H. Schunkert

Authors
  1. P. Groha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Kufner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Ott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Schunkert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Groha.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Groha, P., Kufner, S., Ott, I. et al. Neue ESH/ESC-Leitlinien für die arterielle Hypertonie. Herz 39, 952–956 (2014). https://doi.org/10.1007/s00059-014-4178-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-014-4178-y

Schlüsselwörter

Keywords

Search

Navigation