Neue Studien zur Hypertonie

Abstract

High blood pressure remains a leading risk factor for cardiovascular death worldwide. Optimal medical therapy and blood pressure control are important for the prevention of cardiovascular and renal disease. The present review aims to provide an overview about the innovations and novelties in the field of hypertension. First, new findings concerning optimal blood pressure goals in high-risk patients are presented. Second, developments of established medication regimes, particularly thiazide diuretic, as well as innovations, the angiotensin receptor-neprilysin inhibitor, are reviewed. Finally, pharmacological and non-pharmacological therapeutic options for resistant hypertension are discussed, such as a recent study investigating spironolactone as a 4th-line agent and renal denervation as a continuously evolving treatment option.

Kernaussagen

• Die aktuelle Leitlinie empfiehlt einen Zielblutdruckwert von < 140 /90 mmHg. Die Ergebnisse der SPRINT-Studie zeigen, dass ein SBP unter 120 mmHg – im Vergleich zu einem SBP unter 140 mmHg – die Inzidenz kardiovaskulärer Ereignisse bei Hochrisikopatienten um ungefähr ein Drittel und die Mortalität um ungefähr ein Viertel reduzieren kann.

• Hypokaliämie und Glukoseintoleranz sind Nebenwirkungen unter Therapie mit einem Thiaziddiuretikum. Die PATHWAY-3-Studie ergab, dass eine Kombination von HCT und Amilorid eine effektive Blutdrucksenkung ohne Kalium- und Glukoseveränderungen ermöglicht.

• LCZ696 führt zu einer kombinierten Hemmung des RAS und einer Steigerung natriuretischer Peptide. Hierdurch werden Natriumausscheidung, Vasodilatation und Kardioprotektion vermittelt. In der PARAMETER-Studie war eine 12-wöchige Therapie mit LCZ696 bei Hochrisikopatienten mit isoliert systolischer Hypertonie mit einer effektiven Senkung des zentralen Blutdrucks und Pulsdrucks, des 24-Stunden-Blutdrucks sowie der NT-pro-BNP-Level assoziiert. Diese Abnahme war deutlicher als unter einer Therapie mit einem Angiotensinrezeptorblocker allein.

• Spironolacton ist eine effektive Therapieoption bei Patienten mit therapieresistenter Hypertonie und senkt als Antihypertensivum der vierten Reihe den Blutdruck stärker als Doxazosin oder Bisoprolol. Das Nebenwirkungsprofil der Substanzen war bei 12-wöchiger Therapie vergleichbar.

• Die renale Denervation wird in aktuellen Studien bei Patienten mit unkontrollierter Hypertonie erneut evaluiert. Gemäß den ESC/ESH-Leitlinien ist sie für ausgewählte Patienten mit therapieresistenter Hypertonie unter optimierter medikamentöser Therapie eine mögliche Behandlungsoption.

• Literatur

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