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Orthostatische Hypotension

Diagnostik und Therapie

Orthostatic hypotension

Diagnosis and therapy

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Zusammenfassung

Die Synkope ist ein sehr häufiges klinisches Ereignis in der Bevölkerung und tritt bei fast jedem zweiten Menschen mindestens einmal im Leben auf. Die Reflexsynkope stellt die häufigste Synkopenform dar und wird oft durch orthostatischen Stress ausgelöst. Differenzialdiagnostisch ist eine orthostatische Hypotension (OH) bei jüngeren Patienten eine seltenere, im Alter eine wichtige Ursache. Die Framingham-Studie zeigte eine Zunahme der Inzidenz der OH-bedingten Synkope von 5,7 Ereignissen/1000 Personenjahre im Alter von 60–69 auf 11,1 bei Männern im Alter von 70–79 Lebensjahren. Die OH kann als chronische Erkrankung die Lebensqualität erheblich einschränken. Wesentliche Ursachen sind Volumenverlust, Nebenwirkung von zahlreichen, häufig bei älteren Patienten eingesetzten vasoaktiven Medikamenten, neurodegenerative Erkrankungen sowie Folgen chronischer Stoffwechselerkrankungen wie beispielsweise Diabetes mellitus, M. Addison, Hypothyreose oder einer Amyloidose. Die OH ist schwierig zu behandeln. Therapeutische Ziele sind die lageabhängigen Symptome zu lindern, die Zeit aufrechten Stehens zu verlängern und Synkopen zu verhindern. Eine medikamentöse Therapie ist als Monotherapie nicht ausreichend. Grundlage der Behandlung ist eine individuelle Therapie mit Betonung zahlreicher Allgemeinmaßnahmen, physikalischer Therapie und isometrischer Übungen. In schweren Fällen mit ausgeprägter Symptomatik können additiv Medikamente ergänzt werden, die den periphervaskulären Widerstand erhöhen.

Abstract

Syncope is a frequent clinical event in the general population and occurs in up to every second patient during their lifetime. Reflex syncope is the most prevalent mechanism and is often triggered by orthostatic stress. Orthostatic hypotension (OH) represents a rare cause in young patients but is an important differential diagnosis in the aged. The Framingham study revealed an increase in the incidence of OH-triggered syncope from 5.7 events/1000 person–years at the age of 60–69 to 11.1 in men who are 70–79 years of age. OH often constitutes a chronic, debilitating illness with significant reduction in the quality of life. Important causes are volume loss, side effects of different vasoactive drugs, and neurodegenerative or secondary autonomic diseases following long-standing diabetes or amyloid disease. OH is difficult to treat. The therapeutic goal is to improve postural symptoms, standing time, and prevention of syncopal events. Drug therapy alone is never adequate. Because orthostatic stress varies during the day, a patient-tailored approach that emphasizes education and several general actions is recommended together with physical therapy and isometric exercise maneuvers. Moderate and severe cases require additional drug treatment to increase peripheral vascular resistance.

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  1. I. Medizinische Klinik, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    R. Schimpf, C. Veltmann & M. Borggrefe

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  1. R. Schimpf
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  2. C. Veltmann
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  3. M. Borggrefe
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Correspondence to R. Schimpf.

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Schimpf, R., Veltmann, C. & Borggrefe, M. Orthostatische Hypotension. Herzschr. Elektrophys. 22, 99–106 (2011). https://doi.org/10.1007/s00399-011-0132-3

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