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Therapierefraktäre Hypertonie

Stellenwert neuer Therapiekonzepte

Treatment resistant hypertension

Value of a new treatment concept

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Zusammenfassung

Bei einem Großteil der Patienten mit arterieller Hypertonie kann eine Überaktivität des sympathischen Nervensystems nachgewiesen werden. Die therapieresistente Hypertonie erfordert ein gezieltes diagnostisches Vorgehen zum Ausschluss und ggf. zur kausalen Therapie sekundärer Hypertonieformen. Können sekundäre Ursachen ausgeschlossen werden und erreicht man trotz Optimierung der antihypertensiven Medikation und Ausschöpfung konservativer Maßnahmen nicht das Blutdruckziel, stehen neue invasive Therapiestrategien wie die renale sympathische Denervation oder die Barorezeptorstimulation zur Verfügung. Diese sollten bei ausgewählten Patienten mit therapierefraktärer Hypertonie in spezialisierten Zentren zur Anwendung kommen. Für beide Verfahren gibt es noch wenige Daten zur langfristigen Sicherheit und Effektivität. Ihre Anwendung ist derzeit nicht als Alternative zur medikamentösen Therapie zu sehen, sondern als Ultima Ratio bei Versagen der etablierten konservativen Therapieformen. Bislang ist die gute Wirksamkeit der interventionellen Verfahren nur für Patienten belegt, die trotz einer durchschnittlich über 5-fachen antihypertensiven Medikation systolische Blutdruckwerte deutlich über 160 mmHg aufwiesen.

Abstract

Sympathetic overexpression can be found in a majority of hypertensive patients. Resistant arterial hypertension requires a targeted diagnostic procedure in order to exclude secondary causes of hypertension which can be treated specifically with established therapies. If secondary reasons are not identified, the antihypertensive medication is already optimal and lifestyle changes have been realized, but still the goal of antihypertensive therapy cannot be achieved, alternative invasive therapy strategies such as renal sympathetic denervation and baroreflex activation have been developed to achieve blood pressure control. These therapies are restricted to specialized centers which treat well-defined patients with therapy-resistant hypertension. Little long-term data concerning safety and efficacy are available for the two strategies. However, they should preferably be used as an ultima-ratio and add-on pathway to conservative procedures when established medication fails to achieve blood pressure control. To date, the effectiveness of the interventional antihypertensive therapies has only been shown on patients with systolic blood pressure over 160 mmHg and a mean oral medication of five drugs.

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  1. Klinik für Nephrologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    M. Siekierka-Harreis, L.C. Rump &  O. Vonend

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  1. M. Siekierka-Harreis
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  2. L.C. Rump
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  3. O. Vonend
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Correspondence to O. Vonend.

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Siekierka-Harreis, M., Rump, L. & Vonend, O. Therapierefraktäre Hypertonie. Internist 53, 1411–1419 (2012). https://doi.org/10.1007/s00108-012-3134-2

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