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Leitliniengerechte Differenzialtherapie der Hypertonie

Differential hypertensive therapy according to the guidelines

  • Schwerpunkt: Hypertonie
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Zusammenfassung

Ziel der Hochdruckbehandlung ist es, den Blutdruck zu senken und dadurch das kardiovaskuläre Risiko der Patienten zu verringern. Für diese Therapie stehen Allgemeinmaßnahmen sowie Antihypertensiva zur Verfügung. Bei der Mehrzahl der Hypertoniker gelingt es allein mit Allgemeinmaßnahmen nicht, den Blutdruck ausreichend zu senken. Bei allen Hypertonikern soll der Blutdruck auf <140/90 mmHg gesenkt werden. Bei Diabetikern, Patienten mit Niereninsuffizienz sowie bei Patienten mit Folgekrankheiten der Hypertonie und dadurch sehr hohem kardiovaskulärem Risiko ist der Zielblutdruck <130/80 mmHg. Diuretika, β-Blocker, Kalziumantagonisten, ACE-Inhibitoren und AT1-Antagonisten sind die Antihypertensiva der ersten Wahl. Die Auswahl unter diesen Substanzgruppen erfolgt auf Grund von zu erwartenden Nebenwirkungen sowie unter Berücksichtigung von Begleit- und Folgekrankheiten. Dabei sollte man in Betracht ziehen, dass der wesentliche Nutzen der antihypertensiven Behandlung auf der Blutdrucksenkung an sich beruht und dass die meisten Hypertoniker zum Erreichen des Zielblutdrucks eine Kombination von 2 oder mehr Antihypertensiva benötigen.

Abstract

The goal of antihypertensive therapy is to lower blood pressure and, by doing so, to decrease cardiovascular risk. Life style changes and drugs are available for the treatment of hypertensive patients. In order to reach the target blood pressure, most patients with hypertension need drug treatment in addition to life style changes. In all hypertensive patients, the target blood pressure is <140/90 mmHg. In patients with diabetes mellitus, with chronic renal failure as well as in patients with complications of hypertension and, thereby a very high cardiovascular risk, the target blood pressure is <130/80 mmHg. Diuretics, beta-blockers, calcium antagonists, ACE-inhibitors and angiotensin receptor blockers are the drugs of first choice in the treatment of hypertension. The selection among these drug classes has to consider probable side effects as well as accompanying diseases and complications of hypertension. One should also take into account that most of the beneficial effects of antihypertensive therapy is due to the decrease of blood pressure per se and that the majority of hypertensive patients require the combination of two or more antihypertensive drugs in order to reach the target blood pressure.

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Der korrespondierende Autor weist auf folgende Beziehungen hin:

Referent für die Firmen Asche-Chiesi, Daiichi Sankyo, Pfizer und Torrent.

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  1. Universitätsklinikum Münster, Potstiege 42, 48161, Münster, Deutschland

    K.H. Rahn

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Rahn, K. Leitliniengerechte Differenzialtherapie der Hypertonie. Internist 50, 433–441 (2009). https://doi.org/10.1007/s00108-008-2292-8

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