Die J-Kurve – Schaden wir unseren Hochdruckpatienten durch eine zu aggressive antihypertensive Therapie?

Bluthochdruck ist derzeit der weltweit größte Mortalitätsrisikofaktor. Die therapeutische Blutdrucksenkung führt zu einer signifikanten Senkung der kardiovaskulären Morbidität und Mortalität. Eine zu starke therapeutische Senkung erhöhter Blutdruckwerte lässt jedoch die Morbidität und Mortalität im Sinne eines J-Kurven-Phänomens wieder ansteigen. Wo diese Grenzen jedoch liegen und ob wir sie mit unseren Therapien häufig erreichen, ist nicht klar. Es gibt kaum Daten aus randomisierten und kontrollierten Studien, die diese Fragen adressieren. Somit gibt es hier keine Evidenz, es existieren nur Hinweise. Die stärksten Hinweise für das Vorliegen eines J-Kurven-Phänomens bei der antihypertensiven Therapie finden sich für Patienten mit koronarer Herzerkrankung und nicht operativ oder interventionell versorgten Koronarstenosen. Bei diesen Patienten sollten wir eine zu starke Blutdrucksenkung vermeiden. Zur genaueren Klärung der Frage nach unteren Grenzwerten einer antihypertensiven Therapie bedarf es in der Zukunft randomisierter und kontrollierter klinischer Studien.

Hypertension is the currently the most important mortality risk factor worldwide. Its treatment substantially decreases cardiovascular morbidity and mortality. A to aggressive lowering of blood pressure results in a rerise of morbidity and mortality in terms of a j-curve-phaenomenon. But the blood pressure values for the nadir of this j-curve are not known, because there are almost no data from randomized controlled trials adressing this question. There ist no evidence, only hints support the existence of a j-curve-phaenomenon associated with antihypertensive therapy. The strongest hints can be found for patients with coronary artery disease und surgically or interventionally not treated coronary stenoses. In these patients a to aggressive therapeutic blood pressure lowering should be avoided. There is a need for randomized controlled clinical trials to answer the question for the limiting lower blood pressure values in antihypertensive therapy.

Key words

J-curve - hypertension - diastolic blood pressure - cardiovascular morbidity - cardiovascular mortality - blood pressure values - antihypertensive therapy

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