Blutdruckzielwerte – Was ist bei Niereninsuffizienz zu beachten?

Es ist unbestritten, dass die Blutdruckeinstellung bei Patienten mit Nierenfunktionsschaden und auch Nierenfunktionsversagen essenziell ist. In den letzten Jahren sind hierbei umfangreiche Erfolge in der Reduktion der Blutdruck assoziierten kardiovaskulären Mortalität und auch Morbidität erreicht worden. Ein wichtiger Punkt in der alltäglichen Praxis ist jedoch zu wissen, wir stark man bei einem Patienten zur Optimierung seines Risikos den Blutdruck senken soll. In den letzten 2 Jahren sind hierzu umfangreiche Empfehlungen europäischer und auch internationaler hypertensiologischer bzw. nephrologischer Fachgesellschaften erschienen, die die Blutdruckziele neu definieren und auch die Empfehlungen begründen. In diesem Beitrag werden die Empfehlungen kurz vorgestellt und auch kritisch gewertet. Interessant ist, dass scheinbar in fast allen Lebenslagen bei einer Störung der Nierenfunktion ein Blutdruck von unter 140/90 mmHg angestrebt werden soll. Nur in einigen Fällen, nach Nierentransplantation bzw. bei Patienten mit ausgeprägter Proteinurie, mag eine Blutdrucksenkung auf unter 130/80 mmHg sinnvoll sein.

There is no doubt that blood pressure control is essential in patients with renal dysfunction and end-stage renal disease. In the last decades, multiple effort was achieved by reduction of hypertension-associated mortality and morbidity. An important point in daily practice is a good information for doctors and patients which blood pressure goals should be achieved. Recent guidelines by various hypertension and/or nephrology expert consensus conferences were published in the last years. Blood pressure treatment target values were carefully reviewed and published as a result of current evidence-based medicine. The present review wants to give an overview on current recommendations. There is a critical appraisal in this review. Interestingly, in times of personal medicine there seems to be one blood pressure value in nearly every life situation (< 140/90 mmHg). In some very special cases, like after renal transplantation, blood pressure is recommended below 130/80 mmHg, but even under this condition, evidence grade is very low due to missing studies.

Key words

blood pressure goals - renal insufficiency - hypertension - guidelines - recommendations

• Literatur

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