Vaskuläres Risiko steigt signifikant - Diabetes und Hypertonie als unheilvolle Allianz

Zusammenfassung

Die Hypertonie und besonders der Diabetes mellitus Typ 2 sind rasant wachsende Krankheitszustände, die in Kombination zu einer rasch progredienten vaskulären Schädigung führen. Über die damit induzierte endotheliale Dysfunktion tragen Plaquebildung und -ruptur zur signifikanten Erhöhung der kardio- und zerebrovaskulären sowie der renalen Morbidität und Mortalität bei. Diesem hohen Risiko ist in der Diagnostik und Konsequenz der Therapie Rechnung zu tragen. Dabei spielt die Normalisierung des Blutdrucks auf Werte unter 130/80 mmHg neben dem multifunktionellen Interventionsansatz (Blutzucker, Lipide, Gerinnung) eine besondere Rolle. Aus organprotektiver Sicht bewähren sich vor allem Hemmstoffe des Renin-Angiotensin-Systems in der Kombination mit Kalziumantagonisten, niedrig dosierten Diuretika und bei kardialer Indikation (bevorzugt vasodilatierenden) Betarezeptorenblockern.

Summary

Arterial hypertension and even more type 2 diabetes are diseases with increasing prevalence. If combined they cause serious vascular damage by promoting endothelial dysfunction and arteriosclerotic plaque formation. Patients that suffer from both pathological conditions exhibit a significantly increased risk of developing atherosclerosis with all the fatal complications as myocardial infarction, chronic heart failure, renal insufficiency, and stroke, respectively. To reduce this highly increased risk therapy has to be multimodal and must be monitored precisely. Besides normalizing increased levels of blood glucose and lipids, the blood pressure goal to achieve is 130/80 mmHg. For inhibiting cardiac remodelling and the progression of renal failure, AT₁-Antagonists or ACE inhibitors have been shown to be the drugs of choice. They should be administered together with calcium channel antagonists and/or diuretics. If ischemic heart disease/chronic heart failure is present, beta-blockers are indicated.

Key words

diabetes mellitus type 2 - hypertension - antihypertensive treatment - diagnostic procedures

Literatur

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1 Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe

2 Effect of potentially modifiable risk factors associated with myocardial infarction

3 UK Prospective Diabetes Study

4 Hypertension Optimal Treatment

5 Treatment of Hypertension according to home or Office blood Pressure

6 Atherosclerosis Risk In Communities

7 CAPtopril Prevention Project

8 Losartan Intervention For Endpoint reduction in hypertension

9 Systolic Hypertension in the Elderly Program

10 Systolic hypertension - Europe

11 BErgamo NEphrologic DIabetes Complications Trial

12 Irbesartan MicroAlbuminuria

13 Irbesartan type 2 Diabetic Nephropathy Trial

14 Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan

15 Diabetics Exposed to Telmisartan and Enalapril

Anschrift für die Autoren