Einsatz von Diuretika in der Bluthochdrucktherapie

ZUSAMMENFASSUNG

Zusammenfassend stellt die diuretische Therapie eine wichtige Option in der antihypertensiven und kardiovaskulären Therapie dar. Seit der Entwicklung der Thiaziddiuretika in den 1960er-Jahren ist die diuretische Therapie vielfältiger geworden. Trotz der nun seit Jahrzenten bestehenden Erfahrung in der Therapie sind doch viele Fragen zur Wahl des richtigen Diuretikums, der richtigen Kombination oder Dosis für den individuellen Patienten nicht abschließend geklärt. Zudem ist die Studienlage uneinheitlich und in einigen Fragen weiterhin unzureichend. Daher bedarf es für die optimale Therapie immer noch der Expertise und Erfahrung des jeweiligen Hypertensiologen. Gleichzeitig wurden bereits neue diuretisch wirksame Therapieoptionen entwickelt, die häufig in Kombination mit den etablierten Diuretikaklassen eingesetzt werden, sodass hier mögliche Interaktionen zu bedenken sind. Weitere spezifische Diuretika sind in der Entwicklung, die neben der Blutdruckreduktion reno- und kardioprotektive Eigenschaften besitzen und unsere therapeutischen Möglichkeiten, insbesondere bei Patienten mit einer chronischen Nierenerkrankung (CKD: Chronic Kidney Disease), erweitern können.

Publication History

Article published online:
06 November 2023

• Literatur

• 1 Stamler J, Neaton JD. The Multiple Risk Factor Intervention Trial (MRFIT)--importance then and now. JAMA 2008; 300: 1343-1345
• 2 Liang W, Ma H, Cao L. et al Comparison of thiazide-like diuretics versus thiazide-type diuretics: a meta-analysis. J Cell Mol Med 2017; 21: 2634-2642
• 3 Ishani A, Cushman WC, Leatherman SM. et al Chlorthalidone vs. hydrochlorothiazide for hypertension-cardiovascular events. N Engl J Med 2022; 387: 2401-2410
• 4 Agarwal R, Sinha AD, Cramer AE. et al Chlorthalidone for hypertension in advanced chronic kidney disease. N Engl J Med 2021; 385: 2507-2519
• 5 Musini VM, Rezapour P, Wright JM. et al Blood pressure-lowering efficacy of loop diuretics for primary hypertension. Cochrane Database Syst Rev 2015; 2015: CD003825
• 6 Vasavada N, Saha C, Agarwal R. A double-blind randomized crossover trial of two loop diuretics in chronic kidney disease. Kidney Int 2003; 64: 632-640
• 7 Abraham B, Megaly M, Sous M. et al Meta-analysis comparing torsemide versus furosemide in patients with heart failure. Am J Cardiol 2020; 125: 92-99
• 8 Greene SJ, Velazquez EJ, Anstrom KJ. et al Effect of torsemide versus furosemide on symptoms and quality of life among patients hospitalized for heart failure: The TRANSFORM-HF randomized clinical trial. Circulation 2023; 148: 124-134
• 9 Mentz RJ, Anstrom KJ, Eisenstein EL. et al Effect of torsemide vs furosemide after discharge on all-cause mortality in patients hospitalized with heart failure: The TRANSFORM-HF randomized clinical trial. JAMA 2023; 329: 214-223
• 10 Wouda RD, Boekholdt SM, Khaw KT. et al Sex-specific associations between potassium intake, blood pressure, and cardiovascular outcomes: the EPIC-Norfolk study. Eur Heart J 2022; 43: 2867-2875
• 11 Oxlund CS, Buhl KB, Jacobsen IA. et al Amiloride lowers blood pressure and attenuates urine plasminogen activation in patients with treatment-resistant hypertension. J Am Soc Hypertens 2014; 08: 872-881
• 12 Williams B, MacDonald TM, Morant S. et al Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet 2015; 386: 2059-2068
• 13 Rosa J, Widimský P, Toušek P. et al Randomized comparison of renal cenervation versus intensified pharmacotherapy including spironolactone in true-resistant hypertension. Hypertension 2015; 65: 407-413
• 14 Matsumoto Y, Mori Y, Kageyama S. et al Spironolactone reduces cardiovascular and cerebrovascular morbidity and mortality in hemodialysis patients. J Am Coll Cardiol 2014; 63: 528-536
• 15 Eskandari D, Zou D, Grote L. et al Acetazolamide reduces blood pressure and sleep-disordered breathing in patients with hypertension and obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med 2018; 14: 309-317
• 16 Mullens W, Dauw J, Martens P. et al Acetazolamide in acute decompensated heart failure with volume overload. N Engl J Med 2022; 387: 1185-1195
• 17 Zinman B, Wanner C, Lachin JM. et al Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373: 2117-2128
• 18 Anker SD, Butler J, Filippatos G. et al Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 2021; 385: 1451-1461
• 19 Wanner C, Inzucchi SE, Lachin JM. et al Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016; 375: 323-334
• 20 Packer M, Anker SD, Butler J. et al Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020; 383: 1413-1424
• 21 Cherney DZI, Zinman B, Inzucchi SE. et al Effects of empagliflozin on the urinary albumin-to-creatinine ratio in patients with type 2 diabetes and established cardiovascular disease: an exploratory analysis from the EMPA-REG OUTCOME randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2017; 05: 610-621
• 22 Rossing P, Inzucchi SE, Vart P. et al Dapagliflozin and new-onset type 2 diabetes in patients with chronic kidney disease or heart failure: pooled analysis of the DAPA-CKD and DAPA-HF trials. Lancet Diabetes Endocrinol 2022; 10: 24-34
• 23 Heerspink HJL, Jongs N, Chertow GM. et al Effect of dapagliflozin on the rate of decline in kidney function in patients with chronic kidney disease with and without type 2 diabetes: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol 2021; 09: 743-754
• 24 Jongs N, Greene T, Chertow GM. et al Effect of dapagliflozin on urinary albumin excretion in patients with chronic kidney disease with and without type 2 diabetes: a prespecified analysis from the DAPA-CKD trial. Lancet Diabetes Endocrinol 2021; 09: 755-766
• 25 Inzucchi SE, Claggett BL, Vaduganathan M. et al Efficacy and safety of dapagliflozin in patients with heart failure with mildly reduced or preserved ejection fraction by baseline glycaemic status (DELIVER): a subgroup analysis from an international, multicentre, double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2022; 10: 869-881
• 26 Wiviott SD, Raz I, Bonaca MP. et al Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019; 380: 347-357
• 27 Solomon SD, McMurray JJV, Claggett B. et al Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 2022; 387: 1089-1098
• 28 Heerspink HJL, Stefánsson BV, Correa-Rotter R. et al Dapagliflozin in patients with chronic kidney disease. N Engl J Med 2020; 383: 1436-1446
• 29 McMurray JJV, Solomon SD, Inzucchi SE. et al Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019; 381: 1995-2008
• 30 Papadopoulou E, Loutradis C, Tzatzagou G. et al Dapagliflozin decreases ambulatory central blood pressure and pulse wave velocity in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled clinical trial. J Hypertens 2021; 39: 749-758
• 31 Tikkanen I, Narko K, Zeller C. et al Empagliflozin reduces blood pressure in patients with type 2 diabetes and hypertension. Diabetes Care 2015; 38: 420-428
• 32 Agarwal R, Ruilope LM, Ruiz-Hurtado G. et al Effect of finerenone on ambulatory blood pressure in chronic kidney disease in type 2 diabetes. J Hypertens 2023; 41: 295-302
• 33 Pitt B, Jaisser F, Bakris G. An evaluation of KBP-5074 in advanced chronic kidney disease with uncontrolled hypertension. Expert Opin Investig Drugs 2021; 30: 1017-1023
• 34 Freeman MW, Halvorsen YD, Marshall W. et al Phase 2 trial of baxdrostat for treatment-resistant hypertension. N Engl J Med 2023; 388: 395-405
• 35 Chen HH, Wan SH, Iyer SR. et al First-in-human study of MANP: a novel ANP (atrial natriuretic peptide) analog in human hypertension. Hypertension 2021; 78: 1859-1867