Qualität der Blutdruckeinstellung in der hausärztlichen Praxis unter Verwendung der 24-Stunden-Langzeitblutdruckmessung – eine retrospektive monozentrische Querschnittsstudie

Zusammenfassung

Einleitung Die Diagnostik und Therapie der arteriellen Hypertonie ist eine kontinuierliche Herausforderung in Hausarztpraxen. Ziel dieser Arbeit ist es, die Art und Effektivität der Blutdruckeinstellung bei Patienten mit bekannter arterieller Hypertonie in einer hausärztlichen Praxis unter strikter Verwendung der Office- (OBPM) und ambulanten Langzeit- (ABPM) Blutdruckmessung zu analysieren.

Methoden Retrospektiv wurden 283 Patienten (90 % aller regelmäßig betreuten Hypertoniker) hinsichtlich des Erreichens der Zielblutdruckwerte in ABPM und OBPM der zurückliegenden 1 bis 2 Jahre untersucht. Die Zielwerte entsprachen den geltenden ESH-Empfehlungen (Office-Blutdruck < 140/90 mmHg, 24-h-Mittelwert der ABPM < 130/80 mmHg).

Ergebnisse Der OBPM aller Patienten (Alter: 68 ± 12,7, 48 % Frauen) lag bei 132 ± 11,8/80 ± 4,2 mmHg, der 24-h-ABPM betrug 128 ± 10,7/74 ± 7,9 mmHg. Eine isolierte Praxishypertonie hatten 11,3 %, eine maskierte Hypertonie 21,9 %. Nur 33,9 % wiesen ein physiologisches Dippingverhalten auf (49,1 % Non-Dipper, 13,8 % Reverse-Dipper und 3,2 % Extrem-Dipper). Die Blutdruck-Kontrollrate (Erreichen des Zielblutdruckes) betrug 67,8 % in der OBPM und 57,2 % in der 24-h-ABPM. 23,0 % wurden mit einer Monotherapie, 37,5 % mit Zweifach-Kombination, 19,8 % mittels Dreifach-Kombination und 14,5 % mit > 3 Antihypertensiva behandelt, 83,9 % erhielten RAS-Blocker. Der OBPM-Zielwert wurde bei 75,0 % unter einer Dreifach- und 71,7 % unter einer Zweifach-Kombination erzielt, der 24-h-ABPM-Zielwert zumeist bei Patienten, die nur einer Monotherapie bedurften (66,2 %) oder mittels Zweifachtherapie behandelt wurden (60,4 %), ansonsten < 60 % Zielwerterreichung.

Schlussfolgerung In der untersuchten Hausarztpraxis war die Therapiekontrolle von Patienten mit therapierter arterieller Hypertonie mehrheitlich leitliniengerecht und besser als in der Literatur beschrieben. Die parallele und konsequente Durchführung von OBPM und ABPM sowie die hohe Verschreibungsrate von RAS-Blockern und empfohlenen Kombinationstherapien könnte hierfür der Schlüssel sein.

Abstract

Introduction The diagnosis and therapy of arterial hypertension is a continuous challenge in general practice. The aim of this study is to analyze the nature and effectiveness of blood pressure control in patients with known arterial hypertension in a primary care practice using office- (OBPM) and ambulatory (ABPM) blood pressure measurement.

Methods 283 patients (90 % of all regularly treated patients having hypertension) were retrospectively examined for the achievement of the target blood pressure values in ABPM and OBPM in the past 1 to 2 years. Target blood pressure levels were in line with current ESH recommendations (office blood pressure < 140/90 mmHg, mean 24-h ABPM < 130/80 mmHg).

Results The OBPM of all patients (age: 68 ± 12.7, 48 % women) was 132 ± 11.8/80 ± 4.2 mmHg, the 24-h ABPM was 128 ± 10.7/74 ± 7.9 mmHg. An isolated office hypertension had 11.3 %, a masked hypertension 21.9 %. Only 33.9 % had physiological dipping behavior (49.1 % non-dipper, 13.8 % reverse dipper and 3.2 % extreme dipper). The blood pressure control rate (reaching the target blood pressure) was 67.8 % in the OBPM and 57.2 % in the 24-h ABPM. 23.0 % were treated with monotherapy, 37.5 % with dual combination, 19.8 % with a triple combination and 14.5 % with > 3 antihypertensives. 83.9 % of all had RAS blockers. The OBPM target was achieved in 75.0 % under a triple and 71.7 % under dual combination. The 24-hour ABPM target was mostly achieved in patients requiring only monotherapy (66.2 %) or dual therapy (60.4 %); others < 60 %.

Conclusion In the family practice examined, the treatment control of patients with arterial hypertension was mostly guideline-based and better than described in the literature. The parallel and consistent implementation of ABPM in addition to OBPM as well as the high prescription rate of RAS blockers and recommended combination therapies might be the key for this result.

Schlüsselwörter

arterielle Hypertonie - Hausarzt - Praxismessung - ambulante 24-Stunden-Langzeitblutdruckmessung - Blutdruckeinstellung

Key words

arterial hypertension - general practice - office blood pressure measurement - ambulatory blood pressure monitoring - blood pressure control

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