Adipositas-assoziierte Hypertonie

Zusammenfassung

Hypertonie ist die häufigste Adipositas-assoziierte Erkrankung. Erhöhte Sympathikusaktivität, erhöhtes Blutvolumen und damit zusammenhängende hämodynamische Änderungen, renale Natriumretention, ein dennoch aktiviertes Renin-Angiotensin-Aldosteron-System und Mediatoren aus dem Fettgewebe tragen insgesamt zur Blutdruckerhöhung bei Adipositas bei. Eine Blutdruckreduktion durch Gewichtsreduktion ist möglich, aber schwer zu quantifizieren, da die vorliegenden Studien sehr heterogen sind. Dennoch ist Gewichtsreduktion sinnvoll, um das Erreichen der Zielblutdruckwerte zu unterstützen.

Im Rahmen der medikamentösen Therapie können außer den ACE-Hemmern oder AT₁-Rezeptorblockern keine Medikamente bzw. Medikamentengruppen herausgehoben werden. Häufig ist ohnehin eine Kombinationstherapie notwendig bzw. Begleiterkrankungen diktieren die Substanzauswahl. Adipöse Patienten sind besonders häufig von therapieresistenter Hypertonie betroffen. Eine sorgfältige Blutdruckmessung zusammen mit der Suche nach Endorganschäden, metabolischen Störungen und Schlafapnoe helfen, die besonders gefährdeten Patienten zu identifizieren.

Summary

Hypertension is the most common obesityassociated disease. Increased sympathetic nervous system activity, increased blood volume and related hemodynamic changes, enhanced renal sodium reabsorption, increased activity of the Renin-Angiotensin-Aldosteron system, and mediators released from adipose tissue lead to rising blood pressure with obesity. Whereas weight reduction may decrease blood pressure, the relationship is difficult to quantify because clinical studies addressing the issue are rather heterogeneous. Nevertheless, blood pressure targets are more easily achieved with reduced body weight.

ACE inhibitors and AT₁-receptor blockers stand out if pharmacological treatment is required, other antihypertensive drug classes do not provide specific advantages. However, combination therapy is often required and comorbidities influence the choice of antihypertensive treatment. Treatment-resistant hypertension is a common condition in obese patients. Thus, reliable blood pressure measurements and diagnosis of end-organ damage, metabolic changes and obstructive sleep will help identifying the patients at highest risk.

Schlüsselwörter

Adipositas - Hypertonie - Gewichtsreduktion - sympathisches Nervensystem - Leptin - Fettgewebe

Keywords

Obesity - hypertension - weight reduction - sympathetic nervous system - leptin - adipose tissue

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