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Leitlinien der antihypertensiven Therapie

Guidelines for management of arterial hypertension

  • Leitthema
  • Published:
Der Nephrologe Aims and scope

Abstract

Die Ergebnisse neuer Studien haben eine Überarbeitung der Leitlinien der Europäischen Gesellschaften für Hypertonie und Kardiologie (ESH/ESC) für die Behandlung der arteriellen Hypertonie notwendig gemacht. In den Leitlinien 2007 wird die Relevanz des gesamten kardiovaskulären Risikos betont, und die Einteilung der Hypertonie erfolgt jetzt anhand einer anderen Graduierung (Stadien 1–3 an Stelle von „mild“ oder „mäßig“). Hinsichtlich der Endorganschäden werden die Testung auf Mikroalbuminurie und die Messung der Nierenfunktion hervorgehoben. Das metabolische Syndrom wird als Risikofaktor dem Diabetes mellitus gleichgestellt und spielt eine größere Rolle bei der Auswahl der Antihypertensiva, da durch ACE-Hemmer und Angiotensinrezeptor-Antagonisten das Risiko für die Entwicklung eines Diabetes mellitus günstig beeinflusst werden kann. Eine neue Indikation für diese Substanzen ist die Prävention des Vorhofflimmerns. Insgesamt wird der Stellenwert einer initialen Kombinationstherapie betont, insbesondere bei hohem kardiovaskulärem Gesamtrisiko und niedrigem Zielblutdruck.

Abstract

The results of recent trials made an update of the guidelines of the European Societies of Hypertension and Cardiology (ESH/ESC) for the treatment of arterial hypertension necessary. In the 2007 guidelines, emphasis is placed on total cardiovascular risk as an indication for antihypertensive treatment. This led to a change in the description of the levels of hypertension from terms such as “mild” or “moderate” to a simple graduation in levels 1–3. In the assessment of target organ damage, testing for microalbuminuria and determination of renal function is highlighted. The metabolic syndrome is put on a par with diabetes mellitus as a risk factor and plays a more important role in the choice of antihypertensives, such as ACE inhibitors and angiotensin receptor antagonists, which have been shown to reduce the risk for developing diabetes. Another novel indication for these drugs is the prevention of atrial fibrillation. Overall, the role of initial combination therapy is strengthened, in particular for patients with high total cardiovascular risk and low target blood pressure.

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  1. Medizinische Klinik 4 – Nephrologie und Hypertensiologie, Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Deutschland

    R.E. Schmieder & M.P. Schneider

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  1. R.E. Schmieder
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  2. M.P. Schneider
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Correspondence to R.E. Schmieder.

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Schmieder, R., Schneider, M. Leitlinien der antihypertensiven Therapie. Nephrologe 2, 441–447 (2007). https://doi.org/10.1007/s11560-007-0116-9

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  • DOI: https://doi.org/10.1007/s11560-007-0116-9

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