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Hypertonie—Folgen am Endorgan Gehirn

  • Schwerpunkt: Endorganschäden
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Zusammenfassung

Die arterielle Hypertonie ist der wichtigste Risikofaktor für den Schlaganfall und die vaskuläre Demenz. Eine konsequente antihypertensive Therapie senkt das Schlaganfallrisiko um 40%. Dabei sind wahrscheinlich alle Antihypertensiva außer α-Blockern gleich wirksam. Beim akuten Schlaganfall kommt es häufig zu einem spontanen Blutdruckanstieg. Nach derzeitigem Kenntnisstand sollten abrupte Blutdrucksenkungen in dieser Phase vermieden werden. In der Sekundärprävention nach transitorisch ischämischer Attacke oder Schlaganfall reduziert die Kombination eines ACE-Hemmers mit einem Diuretikum die Schlaganfallhäufigkeit um 28%. Ob diese Risikoreduktion substanzspezifisch ist oder für alle Antihypertensiva identisch ist wird derzeit untersucht.

Abstract

Hypertension is the most important risk factor for stroke and vascular dementia. Antihypertensive treatment reduces stroke risk by 40%. Most probably all antihypertensive drugs are equally effective with the exception of alpha-blockers. Blood pressure is increased in many patients with acute stroke. In this phase sudden drops in blood pressure should be avoided. The combination of an ACE-inhibitor and a diuretic reduced strokes by 28% after TIA or a first stroke. Whether this is a drug specific effect or due to lowering blood pressure per se is investigated at the moment.

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Literatur

  1. Broderick J, Brott T, Barsan W et al. (1993) Blood pressure during the first minutes of focal cerebral ischemia. Ann Emerg Med 22: 1438–1443

    Google Scholar 

  2. Brown MJ, Palmer CR, Castaigne A et al. (2000) Morbidity and mortality in patients randomised in double-blind treatment with a long-acting calcium-channel blocker or diuretic in the international nifedipine GITS study: intervention as a goal in hypertension treatment (INSIGHT). Lancet 356: 366–372

    Google Scholar 

  3. Carlberg B, Asplund K, Hägg E (1993) The prognostic value of admission blood pressure in patients with acute stroke. Stroke 24: 1372–1375

    Google Scholar 

  4. Dahlof B, Devereux RB, Kjeldsen SE, et al. and the LIFE Study Group (2002) Cardiovascular morbidity and mortality in the Losartan intervention for endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359: 995–1003

    Google Scholar 

  5. Grau AJ, Weimar C, Buggle F et al. (2001) Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 32: 2559–2566

    Google Scholar 

  6. Gueyffler F, Bulpitt C, Boissel JP et al. for the INDANA Group (1999) Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. Lancet 353: 793–796

    Google Scholar 

  7. Hansson L, Hedner T, Lund-Johansen P et al. for the NORDIL study group (2000) Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the nordic diltiazem (NORDIL) study. Lancet 356: 359–365

    Google Scholar 

  8. Hansson L, Lindholm LH, Ekbom T et al. (1999) Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in old patients with hypertension-2 study. Lancet 354: 1751–1756

    Google Scholar 

  9. Hansson L, Lindholm LH, Niskanen L et al. for the Captopril Prevention Project (CAPP) Study Group (1999) Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPP) randomised trial. Lancet 353: 611–616

    Google Scholar 

  10. 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

    Google Scholar 

  11. Hypertension Detection And Follow-Up Program Cooperative Group (1979) Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 242: 2562–2571

    Google Scholar 

  12. Hypertension-Stroke Cooperative Study Group (1974) Effect of antihypertensive treatment on stroke recurrence. JAMA 229: 409–418

    Google Scholar 

  13. Jorgensen HS, Nakayama H, Christensen HR, Raaschou HO, Kampmann JP, Olsen TS (2002) Blood pressure in acute stroke. The Copenhagen stroke study. Cerebrovasc Dis 13: 204–209

    Google Scholar 

  14. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1994) Effect of blood pressure and diabetes on stroke in progression. Lancet 344: 156–159

    Google Scholar 

  15. Leonardi-Bee J, Bath P, Phillips S, Sandercock P, IST Collaborative Group (2002) Blood pressure and clinical outcomes in the International Stroke Trial. Stroke 33: 1315–1320

    Google Scholar 

  16. MacMahon S, Peto R, Cutler J et al. (1990) Blood pressure, stroke and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335: 765–774

    Google Scholar 

  17. Medical Research Council Working Party (1985) MRC trial of treatment of mild hypertension: principal results. BMJ 291: 97–104

    Google Scholar 

  18. PATS Collaborative Group (1995) Post-stroke antihypertensive treatment study. Chin Med J 108: 710–717

    Google Scholar 

  19. Progress Collaborative Group (2001) Randomised trial of a perindopril-based blood-pressure lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 358: 1033–1041

    Google Scholar 

  20. Rodgers A, MacMahon S, Gamble G, Slattery J, Sandercock P, Warlow C (1996) Blood pressure and risk of stroke in patients with cerebrovascular disease. BMJ 313: 147

    Google Scholar 

  21. Schellinger PD, Steiner T (1998) Notfall- und Intensivbehandlung nach Schlaganfall. Nervenarzt 69: 530–539

    Google Scholar 

  22. Schrader J, Lüders S, Kulschewski A et al. on behalf of the ACCESS Study Group (2003) Evaluation of acute candesartan cilexetil therapy in stroke survivors. Stroke 34: in press

  23. SHEP Cooperative Research Group (1991) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 265: 3255–3264

    Google Scholar 

  24. Staessen JA, Fagard R, Thijs L et al. for the Systolic Hypertension in Europe (Syst-Eur) Trial Investigators (1997) Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 350: 757–764

    Google Scholar 

  25. Staessen JA, Gasowski J, Wang JG et al. (2000) Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet 355: 865–872

    Google Scholar 

  26. Staessen JA, Thijs L, O'Brien ET et al. (2002) Ambulatory pulse pressure as predictor of outcome in older patients with hypertension. Am J Hypertens 15: 835–843

    Google Scholar 

  27. Stratton IM, Adler AI, Neil HAW et al. on behalf of the UK Prospective Diabetes Study Group (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BJM 321: 405–412

    Google Scholar 

  28. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (2000) Major cardiovascular events in hypertensive patients randomized to doxazosin versus chlorthalidone. The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 283: 1967–1975

  29. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (2002) Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT). JAMA 288: 2981–2997

    Google Scholar 

  30. The INDANA Project Collaborators (1997) Effect of antihypertensive treatment in patients having already suffered from stroke. gathering the evidence. Stroke 28: 2557–2562

    Google Scholar 

  31. UK-TIA Study Group (1991) The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatr 54: 1044–1054

    Google Scholar 

  32. Wahlgren NG, MacMahon DG, De Keyser J, Indredavik B, Ryman T (1994) Intravenous Nimodipine West European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischaemic stroke. Cerebrovasc Dis 4: 204–210

    Google Scholar 

  33. Wing LHW, Reid CM, Ryan P et al. for the Second Australian National Blood Pressure Study Group (2003) A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 348: 583–592

    Google Scholar 

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Authors and Affiliations

  1. Neurologische Universitätsklinik Essen

    H. C. Diener

  2. Zentrum für Innere Medizin, Universitätsklinikum Essen

    Th. Philipp

  3. Medizinische Klinik, St. Josef-Hospital, Cloppenburg

    J. Schrader

  4. Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen

    H. C. Diener

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  1. H. C. Diener
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  2. Th. Philipp
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  3. J. Schrader
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Correspondence to H. C. Diener.

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Diener, H.C., Philipp, T. & Schrader, J. Hypertonie—Folgen am Endorgan Gehirn. Internist 44, 786–792 (2003). https://doi.org/10.1007/s00108-003-0937-1

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  • DOI: https://doi.org/10.1007/s00108-003-0937-1

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