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Dtsch Med Wochenschr 2018; 143(24): 1745-1748
DOI: 10.1055/a-0622-9131
Klinischer Fortschritt
Geriatrie
© Georg Thieme Verlag KG Stuttgart · New York

Neue europäische Empfehlungen zum Blutdruckmanagement im Alter

2018 ESC/ESH Guidelines for the Management of Arterial Hypertension: What’s New with Regard to Our Older People?
Ute Hoffmann
  Klinik für Allgemeine Innere Medizin und Geriatrie, Angiologie, Diabetologie, Endokrinologie, Nephrologie, Krankenhaus Barmherzige Brüder Regensburg
,
Jan-Marc Thrun
  Klinik für Allgemeine Innere Medizin und Geriatrie, Angiologie, Diabetologie, Endokrinologie, Nephrologie, Krankenhaus Barmherzige Brüder Regensburg
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Publication History

Publication Date:
03 December 2018 (online)

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Was ist neu?

Neuer Standard für Messmethoden Unter anderem ist die korrekte Blutdruckmessung unter standardisierten Bedingungen in den letzten Jahren in den Fokus gerückt. Dies beinhaltet vor allem die richtige Anwendung von validierten Messgeräten und die Einhaltung eines einheitlichen Messablaufs mit Ruhezeit vor der Messung, dem Durchführen von mehreren Messzyklen ebenso wie der Messung im Stehen bei älteren Patienten. Wegen des höheren Auftretens eines Weißkitteleffekts und der orthostatischen Hypotonie sowie zur Therapiekontrolle wird bei älteren Menschen auch immer die häusliche Selbstmessung empfohlen.

Welche Messgeräte für ältere Menschen? Ältere Patienten sollten die Blutdruckmessung mit validierten Oberarmmessgeräten mit gut ablesbarem Display durchführen.

Blutdruckzielwerte Die neuen europäischen Leitlinien zum Management der arteriellen Hypertonie empfehlen konkrete und z. T. niedrigere Blutdruckzielwerte zumindest für fitte ältere Patienten. Bei der Einteilung in Gruppen spiegelt sich v. a. die Berücksichtigung von Frailty, der Selbstständigkeit, der Begleitmedikation und der Therapieverträglichkeit der älteren Menschen wider.

Nicht-medikamentöse und medikamentöse antihypertensive Strategie bei älteren Menschen Auch älteren Menschen sind, sofern möglich, nicht-medikamentöse Maßnahmen zu empfehlen. Als medikamentöse Initialtherapie eignet sich eine Kombinationstherapie beginnend mit den jeweils niedrigsten Dosen, idealerweise als „single pill“.

Abstract

In the “2018 ESC/ESH Guidelines for the management of arterial hypertension” there are new blood pressure (BP) recommendations with regard to older patients based on randomized controlled trials and well-conducted meta-analyses performed during the last years.

It is recommended to base the diagnosis of hypertension on repeated office BP measurements under standardized conditions and in older people in out-of-office BP measurement with ABPM and/or HBPM if logistically and economically feasible. Furthermore lying and standing BP measurements should also be considered in subsequent visits in older people to exclude orthostatic hypotension.

Older people should measure their BP in upper arms by validated devices with a well readable display.

In the new guidelines more attention is directed on frailty, concomitant treatments and independence influencing the likely tolerability of BP-lowering medications. In fit older patients, it is now recommended that systolic BP should be targeted to a BP range of 130 – 139 mmHg, if tolerated.

Lifestyle changes are also recommended in elder patients. Preferred combination therapies are a RAS blocker with a CCB or thiazid diuretic, preferably in a “single pill”. When combination therapy is used, this should be initiated at the lowest available doses in elder people.

Schlüsselwörter

Leitlinien - Blutdruckmanagement - Alter - Blutdruckzielwerte

Key words

ESC/ESH guidelines - arterial hypertension - older patients
 

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