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Nichtmedikamentöse und medikamentöse Therapie bei arterieller Hypertonie

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Non-pharmacological and pharmacological treatment of arterial hypertension

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Der Kardiologe Aims and scope

Zusammenfassung

Eine nachhaltig erfolgreiche Bluthochdruckbehandlung basiert auf einer Kombination von nichtmedikamentösen Behandlungsmaßnahmen und medikamentöser Therapie. Die bewährtesten nichtmedikamentösen Maßnahmen sind 1. körperliche bzw. sportliche Aktivität, 2. Gewichtsreduktion, 3. Diätanpassung und Kochsalzreduktion sowie 4. Nikotinkarenz und mäßiger Alkoholkonsum. Für diese 4 Säulen einer nichtmedikamentösen Therapie wurde in Studien mit Evidenzgrad A ein blutdrucksenkender Effekt nachgewiesen. Für die medikamentöse Therapie stehen 5 Hauptsubstanzgruppen zur Verfügung: Thiaziddiuretika, ACE-Hemmer, AT1-Blocker, Kalziumkanalblocker und Betablocker. Für alle wurde eine sehr gute blutsenkende Wirkung bei gleichzeitig günstigem Nebenwirkungsprofil nachgewiesen. Die initiale Bluthochdrucktherapie kann mit einer Monotherapie erfolgen, häufig ist jedoch eine Therapie mit mehreren Antihypertensiva erforderlich, für die verschiedenste Kombinationspräparate in sinnvoller Wirkstoffkombination und -dosierung zur Verfügung stehen. Für die Behandlung von komorbiden Hypertonikern werden Empfehlungen für eine individualisierte medikamentöse Therapie entsprechend des spezifischen kardiovaskulären Risikos bzw. der Komorbidität gegeben. Die Bluthochdrucktherapie muss kontinuierlich über Jahre hinaus erfolgen. Für einen nachhaltigen Behandlungserfolg ist eine gute Compliance unerlässlich, die durch Einbindung in die Therapie gefördert werden kann und regelmäßig evaluiert werden sollte.

Abstract

A permanent and successful treatment of high blood pressure is based on a combination of non-pharmacological treatment measures and pharmacological therapy. The most proven non-pharmacological measures are physical and sports activities, weight reduction, dietary adaption and reduction of salt intake as well as nicotine abstinence and moderate alcohol consumption. A blood pressure reducing effect of evidence grade A was demonstrated for these 4 pillars of non-pharmacological therapy in studies. For pharmacological treatment five main substance groups are available: thiazide diuretics, ACE inhibitors, AT1 blockers, calcium channel blockers and beta blockers. A very good blood pressure reducing effect with an advantageous side effect profile has been proven for all substances. The initial high blood pressure therapy can be carried out with monotherapy but therapy with several antihypertensives is often necessary for the very varied combination of compounds which are available in a meaningful combination and dosage of effective ingredients. For the treatment of comorbid hypertensive patients recommendations are available for an individualized pharmacological treatment corresponding to the specific cardiovascular risk and comorbidity. High blood pressure therapy must be continuously carried out over many years. For permanent success of the therapy good compliance is indispensible which can be encouraged by integration in the therapy and should be regularly controlled.

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  1. Klinik für Innere Medizin und Nephrologie, Universitätsklinikum der Philipps-Universität Marburg, Baldingerstr. 1, 35033, Marburg, Deutschland

    J. Hoyer

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Dieser Beitrag erschien ursprünglich in der Zeitschrift Herz 2012, 37:728–734. DOI 10.1007/s00059-012-3691-0.

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Hoyer, J. Nichtmedikamentöse und medikamentöse Therapie bei arterieller Hypertonie. Kardiologe 7, 352–361 (2013). https://doi.org/10.1007/s12181-013-0524-1

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