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Medikamentöse antihypertensive Therapie

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Antihypertensive drug therapy

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Zusammenfassung

Die medikamentöse antihypertensive Therapie ist auf allen Ebenen der Prävention eine der erfolgreichsten medizinischen Maßnahmen überhaupt. In Deutschland hat sich die Behandlungssituation in den letzten Jahren deutlich verbessert. Heute steht uns eine breite Palette gut wirksamer und gut verträglicher antihypertensiver Substanzen zur Verfügung. Die Kombinationstherapie hat in der Hypertoniebehandlung eine lange und erfolgreiche Tradition, insbesondere mit sinnvollen fixen Kombinationen. Die Verwendung von fixen Kombinationen ist darüber hinaus der Therapieadhärenz sehr förderlich, denn diese hängt ganz wesentlich von der Anzahl der einzunehmenden Medikamente ab. Zur Diskussion stehen der Stellenwert der β-Blocker und die doppelte Blockade des Renin-Angiotensin-Aldosteron-Systems. Hier muss die Interpretation der entsprechenden Studien sehr sorgfältig betrieben werden. Die blutdrucksenkende Wirkung einer Substanz kann ohne Berücksichtigung der Tageszeit, des Messzeitpunkts und des Zeitpunkts der Einnahme nicht umfassend beurteilt werden. Dies ist besonders wichtig mit Blick auf die 24-h-Wirkung. Ebenso muss eine optimale antihypertensive Therapie hinsichtlich der Dosis und Dosierungsintervalle den individuellen Blutdruckrhythmus über die Zeit berücksichtigen. Die Bedeutung des zentralen (aortalen) Blutdrucks als Zielblutdruck wird zunehmen.

Abstract

Antihypertensive drug therapy is one of the most successful medical measures ever, at all levels. The treatment situation in Germany has clearly improved in recent years. Nowadays, a wide range of very effective and well-tolerated hypertensive substances is available. Combination therapy has a long and successful tradition in hypertensive treatment, especially with suitable fixed combinations. Furthermore, the administration of fixed combinations is very beneficial to therapy adherence because it is essentially dependent on the number of drugs to be taken. The value of beta blockers and the double blockade of the renin-angiotensin-aldosterone system are under discussion and the interpretation of corresponding studies must be conducted very carefully. The hypertensive effect of a substance cannot be comprehensively assessed without taking the time of day, the time point of measurement and the time point of intake into consideration. This is particularly important with respect to the effect over 24 h. Optimal antihypertensive therapy must also take into consideration the individual blood pressure rhythm with respect to the dose and dosing intervals. The importance of the central (aortic) blood pressure as target blood pressure will increase.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Middeke: in den letzten 5 Jahren Vortragshonorare von Berlin-Chemie, Daichii, Novartis, Bayer, Takeda, Glaxo, Servier und Pfizer sowie Honorare für wissenschaftliche Beratung von Novartis.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Hypertoniezentrum München, Excellence Centre of the European Society of Hypertension (ESH), Herzzentrum Alter Hof, Dienerstr. 12, 80331, München, Deutschland

    M. Middeke

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Middeke, M. Medikamentöse antihypertensive Therapie. Internist 56, 230–239 (2015). https://doi.org/10.1007/s00108-014-3570-2

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