Aktuelle Aspekte der Altershypertonie – Epidemiologie, Pathophysiologie und Klinik

Mit dem Lebensalter steigt der systolische Blutdruck kontinuierlich an. Parallel dazu steigt auch der diastolische Blutdruck bis etwa zum 50. Lebensjahr an und nimmt ab dem 60. Lebensjahr wieder ab. Pathophysiologisch liegt diesem Verhalten ein mit dem Alter einhergehender Elastizitätsverlust der proximalen Aorta zugrunde. Während bei jüngeren Patienten am häufigsten eine isolierte diastolische Hypertonie (IDH) und im mittleren Alter hauptsächlich eine kombiniert systolische und diastolische Hypertonie (SDH) auftritt, ist im Alter fast ausschließlich eine isolierte systolische Hypertonie (ISH) zu beobachten. Die Überlegung, generell nur noch den systolischen Blutdruck zu erfassen (systolic pressure is all that matters), vergisst in ihrer Überzeichnung aber die vielen Patienten mit isoliert diastolischen Blutdrucksteigerungen, deren Diagnose und konsekutive Therapie bedeutsam bleibt. Die Senkung insbesondere des systolischen Blutdrucks kann schwierig sein. So zeigen die Hypertonie–Interventionsstudien, dass eine diastolische Blutdrucknormalisierung (< 90 mmHg) fast immer erreicht wurde. Im Gegensatz dazu wurden die systolischen Blutdruckwerte durch die Intervention zwar gesenkt, in der Mehrzahl der Studien jedoch nicht normalisiert (< 140 mmHg).

Systolic blood pressure rises continually with increasing age. Side by side the diastolic blood pressure also rises up to an age of approximately 50 and begins to drop from the age of 60. Pathophysiologically, this course of the blood pressure is due to a loss of elasticity of the proximal aorta with advancing age. Whereas an isolated diastolic hypertonia (IDH) is most frequent in younger patients while at middle age a combined systolic and diastolic hypertonia occurs most often. The generalizing phrase ”systolic pressure is all that matters” ignores the many patients with an isolated diastolic blood pressure increase, the diagnosis and treatment of which remains essential. It may be difficult to reduce especially the systolic pressure. Hypertonic intervention studies have shown that normalization of diastolic pressure has been achieved almost always (<90 mmHg), whereas by contrast the systolic blood pressure was reduced but not normalized in most of the studies (<140 mmHg).

Key words

Advanced–age hypertonia - isolated diastolic hypertonia (IDH) - systolic and diastolic hypertonia (SDH) - isolated systolic hypertonia (ISH) - antihypertensive therapy

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