Zusammenfassung
Von resistenter Hypertonie spricht man, wenn der Blutdruck unter Behandlung mit einem Diuretikum und 2 weiteren blutdrucksenkenden Medikamenten in adäquater Dosierung schlecht eingestellt ist. Die Prävalenz der resistenten Hypertonie steigt an. Nach Ausschluss einer Pseudoresistenz aufgrund mangelnder Therapieadhärenz, sekundärer Hypertonieformen und eines massiven Salzverzehrs soll der Blutdruck der verbliebenen resistenten Hypertoniker nach Meinung einiger Experten mit einem Mineralokortikoidrezeptorblocker oder Minoxidil gut einstellbar sein. Dies war auch meine Einschätzung, bis wir einer Patientin begegneten, die trotz Behandlung mit 7 Antihypertensiva, einem elektrischen Karotissinusstimulator und katheterbasierter renaler Denervierung weiterhin enorm hohe Blutdruckwerte aufwies. Ich bin nun überzeugt, dass es in der Tat eine resistente Hypertonie gibt. Mit einer sorgfältigen Anamnese und Untersuchung sowie dem Nachweis von Medikamentenspiegeln und Ausschluss sekundärer Ursachen kann die Prävalenz solcher Patienten stark reduziert werden.
Abstract
When blood pressure is poorly controlled despite treatment with a diuretic and two antihypertensive drugs at adequate doses, the hypertension is termed resistant. The prevalence of resistant hypertension is increasing. Once pseudo-resistance due to poor compliance, secondary forms of hypertension, and massive salt consumption have been excluded, some authorities maintain that blood pressure can be invariably lowered using minoxidil or mineralocorticoid receptor blockade. I also adhered to this belief until we encountered a patient who despite treatment with seven antihypertensive agents, electrical carotid sinus stimulation, and catheter-based renal denervation continued to exhibit extraordinarily high blood pressure values. I am now convinced that resistant hypertension does indeed exist. The prevalence of such patients can be substantially reduced by means of a thorough history and physical examination, determining drug serum concentrations, and excluding secondary causes.
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Interessenkonflikt. F.C. Luft gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Luft, F. Resistente Hypertonie. Internist 56, 224–229 (2015). https://doi.org/10.1007/s00108-014-3568-9
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DOI: https://doi.org/10.1007/s00108-014-3568-9