Download PDF
Dtsch Med Wochenschr 2020; 145(02): 92-98
DOI: 10.1055/a-1031-0520
Dossier
© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik der sekundären Hypertonie: An was ist bei wem zu denken?

Diagnostics in Secondary Hypertension: What is to Consider?
Oliver Vonend
Further Information

Publication History

Publication Date:
20 January 2020 (online)

Also available at
    Permissions and Reprints

Abstract

The prevalence of arterial hypertension with its cardiovascular diseases like myocardial infarction, stroke, chronic kidney disease and peripheral artery disease is increasing in our aging population. Despite numerous efficient and well-tolerated antihypertensive drugs more than eight million people die worldwide from the consequences of insufficiently controlled hypertension every year. One third of the german adult population suffers from high blood pressure. The fact that in only 50 % of hypertonic patients the blood pressure is on a string is even more disturbing. Several factors can counteract sufficient blood pressure control. This article should help to identify patients with possible secondary hypertension. It is certainly not decisive to request a broad screening for all hypertensive patients. A certain pre-selection of potential patients is mandatory. The most common types of secondary hypertension are discussed and the diagnostic and therapeutic pathways are specified.

Weltweit sterben jährlich knapp 8 Millionen Menschen an den Folgen einer nicht adäquat kontrollierten Hypertonie. Die Prävalenz der arteriellen Hypertonie mit ihren kardiovaskulären Folgeerkrankungen nimmt in unserer immer älter werdenden Gesellschaft stetig zu: In Deutschland leidet jeder 3. Erwachsene unter Bluthochdruck, derzeit ist weniger als die Hälfte davon kontrolliert. Dieser Beitrag soll Hilfestellungen geben, eine mögliche sekundäre Hypertonieursache zu erkennen.

Schlüsselwörter

schwer einstellbare Hypertonie - sekundäre Hypertonie - Nierenarterienstenose - primärer Hyperaldosteronismus

Key words

resistant hypertension - secondary hypertension - renal artery stenosis - primary hyperaldosteronism
 

  • Literatur

  • 1 Diederichs C, Neuhauser H. Regional variations in hypertension prevalence and management in Germany: results from the German Health Interview and Examination Survey (DEGS1). J Hypertens 2014; 32: 1405-1413 ; discussion 1414
    CrossrefPubMedSearch in Google Scholar
  • 2 Williams B, Mancia G, Spiering W. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36: 1953-2041
    CrossrefPubMedSearch in Google Scholar
  • 3 Thomas G, Xie D, Chen HY. et al. Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease: Report From the Chronic Renal Insufficiency Cohort Study. Hypertension 2016; 67: 387-396
    CrossrefPubMedSearch in Google Scholar
  • 4 Potthoff SA, Vonend O. Multidisciplinary Approach in the Treatment of Resistant Hypertension. Curr Hypertens Rep 2017; 19: 9
    CrossrefPubMedSearch in Google Scholar
  • 5 Oberhuber A, Vonend O, Radermacher J. et al. AWMF Leitlinie-S2K Erkrankungen der Nierenarterie 004–008. 2018. Im Internet: https://www.awmf.org/uploads/tx_szleitlinien/004-008l_S2k_Erkrankungender-Nierenarterien_2018-11_01.pdf ; Stand: 01.08.2019
    PubMed
  • 6 Bavry AA, Kapadia SR, Bhatt DL. et al. Renal artery revascularization: updated meta-analysis with the CORAL trial. JAMA Intern Med 2014; 174: 1849-1851
    CrossrefPubMedSearch in Google Scholar
  • 7 Wheatley K, Ives N, Gray R. et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 2009; 361: 1953-1962
    CrossrefPubMedSearch in Google Scholar
  • 8 Ritchie J, Green D, Chrysochou C. et al. High-risk clinical presentations in atherosclerotic renovascular disease: prognosis and response to renal artery revascularization. Am J Kidney Dis 2014; 63: 186-197
    CrossrefPubMedSearch in Google Scholar
  • 9 Bradley TD, Floras JS. Obstructive sleep apnoea and its cardiovascular consequences. Lancet 2009; 373: 82-93
    CrossrefPubMedSearch in Google Scholar
  • 10 Quack I, Fritz A, Rump LC. Sleep apnea syndrome in chronic renal failure. Der Nephrologe 2010; 5: 43-48
    CrossrefPubMedSearch in Google Scholar
  • 11 Funder JW, Carey RM, Mantero F. et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 1889-1916
    CrossrefPubMedSearch in Google Scholar
  • 12 Monticone S, Burrello J, Tizzani D. et al. Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice. J Am Coll Cardiol 2017; 69: 1811-1820
    PubMedSearch in Google Scholar
  • 13 Quack I, Vonend O, Rump LC. Familial hyperaldosteronism I–III. Horm Metab Res 2010; 42: 424-428
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Vonend O, Ockenfels N, Gao X. et al. Adrenal venous sampling: evaluation of the German Connʼs registry. Hypertension 2011; 57: 990-995
    CrossrefPubMedSearch in Google Scholar
  • 15 Schmieder RE, Mahfoud F, Azizi M. et al. European Society of Hypertension position paper on renal denervation 2018. J Hypertens 2018; 36: 2042-2048
    CrossrefPubMedSearch in Google Scholar