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Update Hypertonie

Update hypertension

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Der Diabetologe Aims and scope

Zusammenfassung

In der Diagnostik der Hypertonie ist die ambulante 24-h-Blutdruckmessung unverzichtbar. Sie ist eng mit hypertensiven Endorganschäden assoziiert. Dies gilt auch für die Herzfrequenz, deren prognostische Wertigkeit unter Behandlung nachgewiesen wurde. Kombinationstherapien, auch deren früher Einsatz, haben eine klare Überlegenheit gegenüber einer Dosisverdopplung bei Monotherapie bewiesen, sowohl bezüglich der Blutdrucksenkung, der Compliance als auch der Kardioprotektion. Die therapieresistente arterielle Hypertonie geht mit einer sehr hohen kardiovaskulären Komplikationsrate einher. Die Basistherapie, bestehend aus einem Angiotensinkonversionsenzym(ACE)-Hemmer oder Angiotensinrezeptorblocker, Kalziumantagonisten und Diuretikum, wird bei kardialer Komorbidität durch einen β-Rezeptoren-Blocker ergänzt. Weitergehende pharmakologische Therapieprinzipien müssen sich zunehmend mit der renalen Denervierung messen. Für beide Strategien gilt: Harte Endpunktstudien fehlen, und deren Sicherheit und Verträglichkeit sind sorgfältig zu überwachen. Interessant ist, dass die Antidiabetika wie Exenatid und „Sodium-glucose-cotransporter-2“(SGLT-2)-Inhibitoren eine Blutdrucksenkung als additiven Effekt zur antidiabetogenen Wirkung aufweisen.

Abstract

In the diagnostic workup of hypertensive patients 24 h ambulatory blood pressure is an excellent tool and is associated with hypertensive organ damage. Interestingly, heart rate has emerged as an independent predictor of hypertension and cardiovascular complications of hypertension in untreated hypertensive subjects and a prognostic independent marker of hypertensive complications in treated hypertensive patients. Compared to treatment by doubling the dosage, combination therapy has been found to be superior in reducing blood pressure, improving compliance and the related cardiovascular prognosis. Treatment-resistant hypertension is still a therapeutic challenge and is related to a high complication rate. Nowadays, the basic treatment with an angiotensin conversion enzyme (ACE) inhibitor or angiotensin receptor blocker plus calcium channel blocker plus diuretics, and in cases of cardiac morbidity, plus beta blockers presents a standard combination therapy for this severe form of hypertension. Further pharmacological therapies have now been challenged by renal denervation. Both have in common the fact that they are not supported by morbidity and mortality studies, long-term safety trials or registries. Interestingly, antidiabetic agents such as exenatide and sodium-glucose cotransporter 2 (SGLT2) inhibitors have additive antihypertensive effects.

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Authors and Affiliations

  1. Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland

    R.E. Schmieder

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  1. R.E. Schmieder
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Correspondence to R.E. Schmieder.

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Schmieder, R. Update Hypertonie. Diabetologe 9, 373–379 (2013). https://doi.org/10.1007/s11428-012-1014-y

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  • DOI: https://doi.org/10.1007/s11428-012-1014-y

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