Hochdrucktherapie 2015

Zusammenfassung

Die arterielle Hypertonie ist mit einer aktuellen Prävalenz von 32 % weiterhin eine der häufigsten Erkrankungen des Erwachsenenalters in Deutschland. In den neuen ESH / ESC-Leitlinien von 2013 und den praxisnahen Pocketleitlinien der DHL® / DGK von 2014 sind einige Änderungen in Diagnostik und Therapie enthalten, die in der vorliegenden Arbeit besprochen werden. Die Zielblutdruckwerte wurde vereinfacht, so dass bei fast allen Hypertonikern ein Blutdruckwert von < 140 / 90 mmHg angestrebt werden soll. Ausnahmen sind: Diabetiker, ältere Patienten und bei chronischer Niereninsuffizienz mit Proteinurie, bei denen andere Zielblutdruckwerte gelten. Bei der medikamentösen Therapie gab es keine wesentlichen Änderungen. Die renale Denervation muss in randomisiert, kontrollierten Studien in Deutschland weiter kritisch evaluiert werden, um den Stellenwert des Verfahrens abschließend beurteilen zu können. Sie stellt kein alternatives Verfahren zu einer etablierten medikamentösen und nicht medikamentösen Therapie dar.

Abstract

With an prevalence of 32 %, arterial hypertension remains on of the most common diseases among adults in Germany. The ESH / ESC-guidelines from 2013 and the corresponding pocket guidelines of the DHL^®/ DGK from 2014 contain multiple modifications in diagnosis and therapy that are discussed in the present review. Target blood pressure recommendations have been simplified to < 140 / 90 mmHg for almost all hypertensive patients. Exceptions include: diabetic patients, elderly, and patients with chronic kidney disease and proteinuria. The recommentations for pharmacological antihypertensive therapy remained mainly unchanged. Critical evaluation of renal denervation in therapy resistant hypertension requires additional randomized controlled trials in Germany to finally assess the clinical relevance of this intervention. Currently, renal denervation does not provide an alternative strategy for an establihed pharmacological or non-pharmacological approach.

Schlüsselwörter

Hypertonie - Zielblutdruck - Therapieresistenz - Renale Denervation

Keywords

hypertension - target blood pressure - therapy resistance - renal denervation

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