Stellenwert des Betablockers in der Hypertoniebehandlung – Rückbesinnung auf die individuelle Patientensituation

Die antihypertensive Therapie als solche reduziert das kardiovaskuläre Risiko. Die neuen Leitlinien der ESC geben 5 Klassen als antihypertensiv einsetzbare Medikamente an: Thiaziddiuretika, Calciumantagonisten, ACE-Hemmer, Angiotensin-1-Rezeptorantagonisten und Betablocker. Diese Medikamente können initial als Monotherapie oder in Kombination eingesetzt werden. Betablocker werden besonders bei jüngeren Patienten angewandt, während ältere Patienten eher von Diuretika profitieren. Sehr gut sind Betablocker kombinierbar mit Diuretika und Vasodilatatoren. Insgesamt erbringen Beta1-selektive Betablocker eine überzeugendere Risikoreduktion als nicht selektive. Neuere Betablocker der dritten Generation mit zusätzlich vasodilatierender Wirkkombination sind möglicherweise günstig, erfordern aber noch zusätzliche Studien. Betablocker sollten eingesetzt werden bei Patienten mit koronarer Herzerkrankung (Angina pectoris, Zustand nach Myokardinfarkt), Herzinsuffizienz, tachykarden Herzrhythmusstörungen/Tachyarrhythmie und sind exzellente Kombinationspartner mit Diuretika und Vasodilatatoren. Der Einsatz der Betablocker – wie eines jeden Antihypertensivums – sollte der individuellen Situation des Patienten Rechnung tragen. Bei den meisten unserer – oft multimorbiden – Patienten überwiegt der Vorteil einer Therapie mit Beta-Rezeptor-Antagonisten.

Antihypertensive treatment alone reduces the cardiovascular risk – the new ESC guidelines list 5 classes of drugs with antihypertensive properties: thiazide diuretics, calcium antagonists, ACE-inhibitors, angiotensin1 receptor antagonists and beta blockers. These drugs may be employed initially alone or in combination. Beta blockers are used in particular in younger patients, while older patients tend to profit more from diuretics. A very good option is a combination of beta blockers, diuretics and vasodilators. Overall, beta1 selective beta blockers have a greater risk-reducing effect than nonselective beta blockers. New third-generation beta blockers with an additional vasodilatory effect may prove favourable, but further studies are needed. Beta blockers should be employed in patients with coronary heart disease (angina pectoris, previous myocardial infarction), cardiac insufficiency, tachycardic arrhythmias/tachyarrhythmia and are excellent in combination with diuretics and vasodilators. As with any antihypertensive drug, the use of beta blockers should take account of the individual situation of the patient. In the majority of our – often multimorbid – patients the advantages predominate.

Key words

Beta blockers - hypertension - cardiovascular risk - monotherapy - combination treatment

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