Die Bedeutung der antihypertensiven Therapie für die Prävention zerebrovaskulärer Ereignisse

Zusammenfassung

Eine Vielzahl von Interventionsstudien beweist, dass eine antihypertensive Therapie das Risiko eines Schlaganfalls erheblich reduziert. Dies gilt sowohl für ein erstes Schlaganfallereignis als auch für ein Schlaganfallrezidiv. Weiterhin gilt dies sowohl für hypertensive Patienten als auch für Patienten mit einem Blutdruck von weniger als 140/90 mm Hg, die ein erhöhtes kardiovaskuläres Risikoprofil aufweisen. Jede der fünf wesentlichen Klassen von antihypertensiven Medikamenten (Diuretika, β-Blocker, Kalziumantagonisten, ACE-Hemmstoffe und Angiotensinrezeptorantagonisten) ist effektiv hinsichtlich der Primärprävention des Schlaganfalls. Derzeit noch nicht ausreichend gesicherte Daten, vornehmlich gewonnen aus Metaanalysen, weisen darauf hin, dass Kalziumantagonisten besonders vorteilhaft für die Primärprävention des Schlaganfalls sein könnten. Die Rolle der ACE-Hemmstoffe und der Angiotensinrezeptorantagonisten relativ zu den übrigen Klassen von Antihypertensiva ist noch nicht ausreichend geklärt. Was die Sekundärprävention von zerebrovaskulären Ereignissen anbetrifft, so liegen bislang im Wesentlichen nur Daten für die Therapie mit ACE-Hemmstoffen und Diuretika vor. Es gibt keine verlässlichen Informationen, die auf einen differenziellen Effekt von bestimmten Klassen von Antihypertensiva hinweisen. Entscheidend für die Sekundärprävention von zerebrovaskulären Ereignissen ist die Blutdrucksenkung per se, auch bei Patienten mit Blutdruckwerten von weniger als 140/90 mm Hg. Bei vielen Patienten ist zur effektiven Blutdrucksenkung eine Kombination von Antihypertensiva erforderlich, diese Kombinationstherapie sollte möglichst ein Diuretikum enthalten.

Abstract

Many intervention studies provide a solid base of evidence that antihypertensive therapy lowers the risk of stroke to a substantial degree. This is true for primary prevention of stroke but also for secondary prevention of stroke. The risk reduction is not only observed in hypertensive individuals but also in patients with blood pressures of less than 140/90 mm Hg at a high risk of cardiovascular disease. Any of the five major classes of antihypertensive drugs (diuretics, beta blockers, ACE inhibitors, angiotensin receptor blockers and calcium antagonists) have been shown to effectively reduce the risk of primary stroke in hypertensive patients. At present time there is insufficient evidence to suggest that some classes of antihypertensive drugs are more effective than others for primary prevention of stroke. Available data, primarily driven from meta-analyses, suggest that calcium antagonists are particularly effective in the primary prevention of stroke. The role of ACE inhibitors and of the angiotensin receptor blockers in comparison to the other antihypertensive drug classes needs further clarification. With regards to secondary prevention of stroke, available data are limited mainly to ACE inhibitors and diuretics. There is insufficient evidence regarding any differential effects across antihypertensive drug classes. Crucial for secondary prevention of stroke is blood pressure reduction per se, even in patients with blood pressures of less than 140/90 mm Hg. In many patients, antihypertensive combination therapy is necessary to achieve blood pressure goals. Combination therapy should contain a diuretic whenever possible.

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