Zusammenfassung
Die arterielle Hypertonie ist ein globales und sehr häufiges Problem. In den letzten Jahrzehnten sind umfangreiche Medikationen entwickelt worden, um die Hypertonie zu senken. Aktuell sind neue Medikamente für die Blutdruckbeeinflussung nicht in Sicht. Alternativen, wie interventionelle Verfahren für die Blutdrucksenkung, sind in den letzten Jahren entwickelt und getestet worden. Vor allem die Ablation der renalen sympathischen Nerven (renale Denervation [RDN]), die sich um die Nierenarterien wickeln, wurde intensiv als Verfahren untersucht. Nach den ersten RDN-Studien zeigte sich eine deutliche Blutdruckbeeinflussung. In den ersten Sham-kontrollierten Studien war die Blutdrucksenkung durch die RDN jedoch nicht mehr konsistent zu zeigen. In sehr systematischen Sham-kontrollierten, verblindeten Studien an Patienten mit Hypertonie, aber ohne Medikation konnte ein robuster blutdrucksenkender Effekt nach RDN gezeigt werden, der dem Einsatz eines blutdrucksenkenden Medikaments entspricht. Sicherlich müssen größere Studien und auch Studien mit längerer Laufzeit noch die Effekte nachhaltig bestätigen. Auch die aktive und passive Barorezeptorstimulation konnte in den letzten Jahren zumindest in Studien als blutdrucksenkendes Prinzip etabliert werden, wobei die Evidenz noch sehr überschaubar ist.
Abstract
Arterial hypertension is a real global burden with a very high prevalence. In the last decades, many pharmaceutical approaches have been successfully developed for treating hypertension. Currently, novel medications for influencing blood pressure are not in sight. In recent years alternatives, such as interventional procedures for reducing blood pressure, have been developed and tested. Ablation of the renal sympathetic nerves (renal denervation, RDN), which are wrapped around the renal arteries in particular, has been intensively investigated as a procedure. After the first RDN studies a clear influence on the blood pressure could be shown; however, in the first sham-controlled studies the reduction in blood pressure by RDN could no longer consistently be shown. In very systematic sham-controlled, blinded studies in patients with hypertension but without medication a robust blood pressure reducing effect of RDN could be shown, which corresponded to the effect of a blood pressure-reducing drug. It is obvious that larger studies and also long-term studies have to sustainably confirm this effect. In recent years, active and passive stimulation of the baroreceptors could also be established as a blood pressure reducing principle, at least in studies but the evidence is still very low.
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M. van der Giet hat Honorare für Vorträge bei Medtronic, CVRX, Bayer, Berlin-Chemie, Vifor, Otuka und Beratungshonorare von IEM und Vifor erhalten.
Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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van der Giet, M. Interventionelle Therapien bei Hypertonie – aktueller Stand. Internist 62, 236–244 (2021). https://doi.org/10.1007/s00108-021-00943-z
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DOI: https://doi.org/10.1007/s00108-021-00943-z