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Dtsch Med Wochenschr 2018; 143(04): 236-243
DOI: 10.1055/s-0043-108475
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© Georg Thieme Verlag KG Stuttgart · New York

Medikamentöse Therapie kardiologischer Erkrankungen im Alter

Cardiovascular Medication in Elderly Patients
Robert H.G. Schwinger
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Publication History

Publication Date:
22 February 2018 (online)

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Abstract

Elderly people show increased probability to develop atherosclerotic diseases; in consequence heart failure – most often following coronary heart disease – as well as atrial fibrillation is more common. Following guidelines may lead to polypharmacy, i. e. use of more than 5 drugs daily. Thus, drug interactions as well as side effects become more likely; especially in elderly patients reduced kidney function has to be taken into account. Only drugs which have shown to prolong life or to reduce symptoms in controlled clinical trials should be used. There is little evidence to use low dose aspirin or lipid lowering agents in primary prevention especially in elderly. ACE inhibitors, β blocker and MRA are effective to improve symptoms and outcome in HFrEF but not in HFmEF or HFpEF. This also holds true for the elderly. Withdrawal of long term diuretic treatment in the elderly patients may lead to symptoms of heart failure or increase in blood pressure to hypertensive values often. In coronary heart disease ß blocker may be used to control symptoms as well as to reduce the need for coronary intervention following 1 year after myocardial infarction. Because the risk of stroke increases with age more than the risk of bleeding, the absolute benefit of oral anticoagulation in atrial fibrillation patients is highest in the elderly. NOAK appear to be safer and at least as efficacious as warfarin.

Mit steigendem Alter erhöht sich die Wahrscheinlichkeit, an mehreren Erkrankungen gleichzeitig zu leiden. Vor allem atherosklerotische Gefäßveränderungen sind eine klassische Erkrankung des Alters. Wesentliche Folgekomplikationen sind kardiale und vaskuläre Erkrankungen, für deren Therapie alte Menschen häufig eine Vielzahl von Medikamenten einnehmen. Doch sind diese Medikamente beim alten Menschen wirklich alle notwendig und nützlich?

Schlüsselwörter

Kardiovaskuläre Medikation im Alter - Herzinsuffizienz - koronare Herzerkrankung - Arterielle Hypertonie - Antikoagulation

Key words

cardiovascular medication in the elderly - heart failure - coronary heart disease - arterial hypertension - anticoagulation
 

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