Summary
The treatment and management of patients with arterial hypertension depends on the global cardiovascular risk of the individual patient. Thus, additional cardiovascular risk factors, the presence of target organ damage, cardiovascular or renal disease determine not only the initiation of therapy but also the choice of drug(s). Drug treatment is usually started with one compound, which is selected from 5 drug classes recommended for first-line therapy including ACE-inhibitors, AT1-antagonists, betablockers, calcium channel blockers, and diuretics. Depending on risk and additional disease individual target blood pressures are 140/90, 130/80 or 125/75 mmHg, respectively. If blood pressures at baseline exceeds target values more than 20/10 mmHg treatment may be started with initial or early combination therapy of two drugs. Overall, approximately two-thirds of patients require treatment with at least two drugs to achieve target blood pressure values.
Zusammenfassung
Bei der Hypertoniebehandlung soll sich das therapeutische Vorgehen an einer individuellen Risikoeinschätzung orientieren, da zusätzlich zu dem jeweiligen Blutdruckniveau weitere Risikofaktoren, Endorganschäden und Begleiterkrankungen das kardiovaskuläre Risiko modifizieren und den Therapiebeginn sowie die Differenzialtherapie beeinflussen. Je nach Risikokonstellation, ist eine Blutdrucksenkung unter 140/90, 130/80 oder 125/75 mmHg anzustreben. Die Pharmakotherapie soll in der Regel zunächst mit einem Medikament aus den Substanzklassen der ersten Wahl (ACE-Hemmer, AT1-Rezeptorantagonisten, Betablocker, Calciumantagonisten oder Diuretika) begonnen werden. Wenn der Ausgangsblutdruckwert mehr als 20/10 mmHg über dem individuellen Zielwert liegt, kann eine unmittelbare oder frühe Initialbehandlung mit einer Zweifachkombination erwogen werden. Etwa 2/3 der Patienten müssen kombiniert mit mindestens zwei Medikamenten behandelt werden, um eine Einstellung des Zielblutdruckes zu erreichen.
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Kreutz, R. Hypertonietherapie. Clin Res Cardiol 95 (Suppl 6), vi34–vi40 (2006). https://doi.org/10.1007/s00392-006-1807-3
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DOI: https://doi.org/10.1007/s00392-006-1807-3