Zusammenfassung
Diabetes mellitus und arterielle Hypertonie sind entscheidende
kardiovaskuläre Risikofaktoren, die sich bei gleichzeitigem
Vorliegen potenzieren. Der Nachweis einer Mikroalbuminurie ist ein
wichtiger und unabhängiger Risikomarker für eine
erhöhte Morbidität und Mortalität beider
Erkrankungen. Regelmäßige Kontrollen sind daher
obligat. Der Zielblutdruck beträgt bei Patienten mit Diabetes
und arteriellem Hypertonus < 130/80 mm Hg,
bei manifester Nephropathie jedoch < 125/75 mm Hg.
Die Grundlage jeder Therapie ist eine Lebensstilmodifikation, diese
muss folgende Therapieziele beinhalten: 1. Gewichtsreduktion, 2.
regelmäßige moderate körperliche Aktivität,
3. Umstellung der Ernährung inklusive Alkohol- und Kochsalzrestriktion
sowie 4. ggf. Einstellen des Nikotinkonsums. Als medika-mentöse
Therapeutika sind Renin- und ACE-Inhibitoren sowie AT1-Rezeptor-Antagonisten
Mittel der ersten Wahl; sie hemmen die Progression der Nephropathie
effektiver als andere Antihypertensiva und sollten fester Bestandteil
jeglicher Kombinationstherapie sein.
Summary
Diabetes mellitus and arterial hypertension are major cardiovascular
risk factors with high co-morbidity. Microalbuminuria is an independent risk
marker, and routine monitoring of urinary albumin is mandatory in
patients with diabetes and hypertension. The therapeutic goal of
antihypertensive treatment is < 130/80 mm Hg,
however in the presence of nephropathy < 125/75 mm Hg
should be achieved. Therapy is based on lifestyle-interventions
including 1) weight reduction, 2) regular moderate physical activity,
3) modification of diet with restriction of salt- and alcohol consumption
as well as 4) cessation of smoking. Renin- and ACE-inhibitors as
well as AT1-receptor antagonists are drugs of first choice, delaying
the progression of diabetic nephropathy most effectively.
Schlüsselwörter
Diabetes mellitus - arterielle Hypertonie - Albuminurie - kardiovaskuläres Risiko
- diabetische Nephropathie
Keywords
diabetes mellitus - arterial hypertension - albuminuria - cardiovascular risk - diabetic
nephropathy
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Prof. Dr. med. Hendrik Lehnert
Medizinische Klinik I, Universitätsklinikum
Schleswig-Holstein, Campus Lübeck
Ratzeburger
Allee 160
23538 Lübeck
Phone: 0451/500
2306
Fax: 0451/500 3339
Email: Hendrik.Lehnert@uk-sh.de
