Blutdruckeinstellung und -medikation

Patienten mit terminaler Niereninsuffizienz weisen eine deutlich erhöhte kardiovaskuläre Morbidität und Sterblichkeit auf. Die Ursachen hierfür sind multifaktoriell, wesentlich sind erhebliche Schädigungen der arteriellen Gefäße. Die bei einem großen Teil der Dialysepatienten prävalente arterielle Hypertonie trägt zu der hohen kardiovaskulären Komplikationsrate bei. Wegen der ausgeprägten Alterationen des kardiovaskulären Systems bei Dialysepatienten besteht eine U-förmige Beziehung zwischen Blutdruck vor Dialyse und kardiovaskulärer Komplikationsrate. Blutdruckwerte zwischen 140 und 160 mmHg systolisch vor Dialysebeginn sind mit der geringsten kardiovaskulären Komplikationsrate bei Dialysepatienten assoziiert. Für die Blutdruckkontrolle und die kardiovaskuläre Prognose entscheidend ist die konsequente Einstellung der Patienten auf das Trockengewicht. Darüber hinaus sind bei vielen Patienten Antihypertensiva erforderlich. Es ist bislang nicht definitiv geklärt, ob gewisse Klassen von Antihypertensiva wie z. B. Hemmstoffe des Renin-Angiotensin-Aldosteron-Systems Vorteile gegenüber anderen Klassen von Antihypertensiva haben in Bezug auf die kardiovaskuläre Prognose.

Patients with end-stage renal disease suffer from seriously increased cardiovascular morbidity and mortality. The increased incidence of cardiovascular complications is multifactorial, mainly explained by severe alterations of the arterial wall and the myocardium. Arterial hypertension is prevalent in a large proportion of dialysis patients and contributes to the elevated rate of cardiovascular complications. Because of severe alterations of arterial structure and function, there is a U-shaped relationship between predialysis blood pressure and the incidence of cardiovascular complications. The optimal systolic blood pressure before dialysis appears to be between 140 and 160 mmHg. The most important measures to achieve target blood pressure in dialysis patients consist of probing dry weight and maintaining dietary salt restriction. Many patients need in addition antihypertensive treatment. It is still not established, whether certain classes of antihypertensive drugs, e. g. inhibitors of the renin-angiotensin-aldosterone system, are more advantageous with respect to cardiovascular prognosis of dialysis patients than other classes of antihypertensive drugs.

Key words

dialysis - end-stage renal disease - arterial hypertension - target blood pressure - antihypertensive treatment - cardiovascular complications

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