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Epidemiologie und Ätiologie der therapieresistenten Hypertonie

Epidemiology and etiology of therapy-resistant hypertension

  • Schwerpunkt: Therapierefraktäre und sekundäre arterielle Hypertonie
  • Published:
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Zusammenfassung

Definitionsgemäß liegt eine therapieresistente Hypertonie vor, wenn trotz einer antihypertensiven Dreifachmedikation in maximaler Dosierung, welche ein Diuretikum beinhaltet, die Zielblutdruckwerte <140/90 mmHg (<130/80 mmHg bei Diabetes mellitus oder bei Nierenerkrankung) nicht erreicht werden. Die Therapieresistenz betrifft 4–19% der Patienten mit arterieller Hypertonie. Folge der Therapieresistenz ist ein besonders hohes Risiko für kardiovaskuläre, zerebrovaskuläre und renale Folgeschäden. Abgegrenzt werden muss eine durch inadäquate Medikation, Incompliance und Weißkittelhypertonie bedingte „falsche“ therapieresistente Hypertonie. Eine echte Therapieresistenz ist meist multifaktoriell bedingt: Zu nennen sind v. a. Interferenzen mit weiteren Medikamenten, Volumenüberladung, Lebensstilfaktoren, Komorbiditäten wie chronische Nierenerkrankung oder obstruktives Schlafapnoesyndrom und sekundäre Hypertonieformen wie der primäre Hyperaldosteronismus.

Abstract

Uncontrolled arterial hypertension is a frequent clinical problem, affecting 1/10 of hypertensive subjects, and can lead to severe renal, cerebral and cardiovascular damage. Common causes of poorly controlled blood pressure include lack of compliance, inadequate antihypertensive medication and white-coat hypertension, all referred to as “false” therapy-resistant hypertension. 4–19% of patients with arterial hypertension suffer from “true” therapy-resistant hypertension: this is defined as failure to achieve target blood pressure values despite full-dose triple drug regimen including a diuretic. In most cases, its etiology is multifactorial. Frequent causes include interfering medication, volume overload, chronic kidney disease, obstructive sleep apnea and secondary causes such as primary aldosteronism. Factors such as obesity, high salt intake and excessive alcohol ingestion contribute to poor blood pressure control. This article reviews the literature and describes epidemiology and etiology of therapy-resistant hypertension.

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  1. Medizinische Klinik – Innenstadt, Klinikum der Universität München, Ziemssenstraße 1, 80336, München, Deutschland

    C. Schirpenbach &  M. Reincke

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  1. C. Schirpenbach
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  2. M. Reincke
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Correspondence to M. Reincke.

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Schirpenbach, C., Reincke, M. Epidemiologie und Ätiologie der therapieresistenten Hypertonie. Internist 50, 7–16 (2009). https://doi.org/10.1007/s00108-008-2194-9

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