Summary
Arterial hypertension must also be consistently treated in patients with PAD. Current guidelines and recommendations have to be considered, although in some patients the walk performance may be affected temporary by blood pressure dropping. In PAD, ideal antihypertensives are ACE inhibitors, AT1 receptor antagonists, calcium channel blockers and also alpha receptor blockers in combination. Beta receptor blockers—indicated in coronary heart disease—do not influence pain-free walking distance (PFWD) in patients with PAD. Diuretics should only be given in low dosage and in combination with other antihypertensive drugs in order to avoid a decrease of blood flow ability with clinical events.
Zusammenfassung
Auch bei peripherer arterieller Verschlusskrankheit (PAVK) muss eine arterielle Hypertonie konsequent unter Beachtung der aktuellen Leitlinien und Empfehlungen und vorgegebenen Zielwerte behandelt werden, obwohl bei einigen Patienten durch eine starke Blutdrucksenkung die Gehleistung kurzfristig beeinträchtigt werden kann. Als ideale Antihypertensiva bei PAVK werden ACE-Hemmer, AT1-Rezeptoren-Blocker und Kalziumantagonisten sowie in Kombination auch Alphablocker angesehen. Die wegen häufig gleichzeitig bestehender KHK indizierten Betablocker verkürzen bei Claudicatio intermittens die beschwerdefreie Gehstrecke nicht! Diuretika sollten möglichst nur in Kombination und niedriger Dosierung verabreicht werden, um eine Verminderung der Fließfähigkeit des Blutes und daraus resultierende klinische Ereignisse zu vermeiden.
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References
European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension (2003) J Hypertens 21:1011–1053
Arzneimittelkommission der Deutschen Ärzteschaft (2004) Empfehlungen zur Therapie der arteriellen Hypertonie, 2. Aufl.
Bramlage P, Pitrow D, Kirch W (2004) The effect of irbesartan in reducing cardiovascular risk in hypertensive type 2 diabetic patients: an observational study in 16600 patients in primary care. Curr Med Res Opin 20:1625–1631
Celis H, Yodfat Y, Thijs L et al (1996) Antihypertensive therapy in older patients with isolated systolic hypertension: the Syst-Eur experience in general practice. Fam Pract 13:138–143
Chobanian AV, Bakris GL, Black HR et al (2003) The Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289:2560–2572
Deutsche Hochdruckliga, Deutsche Hypertonie Gesellschaft (2003) Leitlinien für die Prävention, Erkennung, Diagnostik und Therapie der arteriellen Hypertonie
Diehm C, Schuster A, Allenberg JR et al (2004) High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 172:95–105
Domanski M, Mitchell G, Pfeffer M et al (2002) Pulse pressure an cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT). Jama 287:2677–2683
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy (2000) Heart Outcomes Prevention Evaluation Study Investigators. Lancet 355:253–259
Hansson L, Zanchetti A, Carruthers SG et al, for the HOT Study Group (1998) Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 351:1755–1762
Kannel W, Larson M (1993) Long-term epidemiologic prediction of coronary disease. The Framingham experience. Cardiology 82:137–157
Lange S, Trampisch HJ, Haberl R et al (2005) Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level. Atherosclerosis 178:351–357
Lonn EM, Dzavik V, Yusuf S et al (1999) Results of the Study to Evaluate Carotid Ultrasound changes in patients treated with Ramipril and vitamin E (SECURE). Circulation 100 (Suppl I):I–85
Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipidlowering treatment to prevent heart attack trial (ALLHAT). ALLHAT Collaborative Research Group (2000). JAMA 283:1967–1975
TASC Working Group (2000) Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). Int Angiol 19 (Suppl 1):I–XXIV:1–304
The getABI Study Group (2002) The German epidemiological trial on ankle brachial index for elderly patients in family practice to detect peripheral arterial disease, significant marker for high mortality. Vasa 31:241–248
Whitworth JA (2003) World Health Organisation (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 21:1983–1992
Yusuf S, Sleight P, Pogue J et al (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators (HOPE). N Engl J Med 342:145–153
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Sternitzky, R. Risikoadaptierte Therapie von Gefäßerkrankungen—. ZS Kardiologie 94 (Suppl 4), iv19–iv23 (2005). https://doi.org/10.1007/s00392-005-1406-8
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DOI: https://doi.org/10.1007/s00392-005-1406-8