Aktuelle medikamentöse Therapie der chronischen Herzinsuffizienz

Zusammenfassung

ACE-Hemmer (oder alternativ ARBs) und Betablocker bleiben die Basistherapie der systolischen Herzinsuffizienz und müssen aufdosiert werden. Der Indikationsbereich der Aldosteronantagonisten wurde auf das NYHA-Stadium II ausgeweitet. Ivabradin stellt eine zusätzliche Therapieoption dar, wenn trotz aufdosiertem Betablocker die Herzfrequenz im Sinusrhythmus über 70/min liegt. Für Statine und die orale Antikoagulation ergibt sich die Indikation allenfalls aus den Komorbiditäten, nicht aus der Herzinsuffizienz selbst. Zahlreiche Medikamente sollten bei der systolischen Herzinsuffizienz gemieden werden. Diuretika dienen bei Herzinsuffizienz unabhängig von der Pumpfunktion zur Symptomlinderung bei Flüssigkeitsretention. Für die Herzinsuffizienz mit erhaltener Pumpfunktion besteht darüber hinaus vorrangig die Empfehlung zur Blutdruckeinstellung.

Abstract

ACE-Inhibitors (or alternatively ARBs) and beta-blockers remain the first line treatment in systolic heart failure and should be up-titrated to evidence-based target doses. Recommendations for the use of mineralocorticoid receptor antagonists have been extended to all patients in NYHA class II–IV. Ivabradine should be considered in patients in sinus rhythm, EF < 35 % and a heart rate > 70 beats/min despite maximum dosage of betablockers. Statins and oral anticoagulation in patients with sinus rhythm show no benefit for heart failure. Various drugs may cause worsening of heart failure and thus should be avoided due to safety concerns. Diuretics serve for symptom relieve in heart failure with fluid retention independent of the pump function. For heart failure with preserved ejection fraction in addition blood pressure control is of particular relevance.

Schlüsselwörter

Herzinsuffizienz - medikamentöse Therapie - Aldosteronantagonist - Ivabradin

Key words

heart failure - pharmacological therapy - aldosteron antagonist - ivabradine

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