Milde Hypertonie: Was sind die Grenzwerte, wen soll man wie behandeln?

Abstract

For decades, it was not clear how to deal with mild hypertension in patients, especially with low cardiovascular risk. In particular, the findings of the therapy studies, which have rarely examined the uncomplicated mild case of hypertension due to the low expected event rate, certainly suggest that therapy of mild hypertension in a period of 10 years has little effect on the patients. With a longer observation period and also through insights from register analyzes, especially with systematic follow-up, it becomes clear that it makes sense to treat a mild hypertension even at low cardiovascular risk. The Europeans definitely point out the right path in their guidelines. Here, the dilemma exists between the strict evidence base and the expert opinion with extrapolation of data. Patients well below the age of 65 years with mild hypertension and low overall cardiovascular risk should be offered the option to adjust blood pressure even with systolic targets below 130 mmHg. If the patient is older than 65, target blood pressure achievement should not be so ambitious anymore, but also dependent on the tolerance of the patient. Certainly, the practitioner must explain clearly to the younger patient that regular therapy will not necessarily bring him an advantage over the next 10 years, and that the effects may not really materialize until 20 years, and then reduce the risk of stroke or heart attack.

Jedem Praktiker steht ein leitliniengerechtes Repertoire zur Therapie des hohen Blutdrucks zur Verfügung. Doch was ist bei der milden Form der Hypertonie zu tun? Diese hat zwar für viele Patienten keine direkten Konsequenzen für einen Zeitraum von 10 Jahren, kann aber im späteren Verlauf doch zum Apoplex oder zur KHK führen. Anhand der aktuellen Studienlage zeigt dieser Beitrag die Optionen auf.

Schlüsselwörter

Zielblutdruck - stringente Blutdruckziele - kardiovaskuläres Risikoprofil - Nachbeobachtung - Extrapolation

Key words

target blood pressure - tight blood pressure aims - cardiovascular risk profile - follow-up - extrapolation

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