Primäre und sekundäre arterielle Hypertonie – Update 2016

Zusammenfassung

Hypertonie-Patienten ohne Diabetes mit hohem kardiovaskulären Risiko sollten auf einen Ziel-Blutdruck von kleiner als 130 mmHg eingestellt werden. Ältere Hypertoniker, die körperlich fit sind, haben die gleichen Ziel-Blutdruckwerte wie jüngere Hypertoniker, nicht aber gebrechliche Hypertoniker mit einem Alter von über 80 Jahren, die bei straffer Blutdruckeinstellung eine erhöhte Morbidität und Mortalität aufweisen. Bei schlecht einstellbarer oder therapierefraktärer Hypertonie zeigt Spironolacton als vierte antihypertensiv wirksame Substanz zusätzlich zum ACE-Hemmer/Angiotensin-Rezeptorblocker, Kalziumantagonisten und Thiaziddiuretikum den stärksten Effekt.

Abstract

In patients with hypertension without diabetes and with an increased risk of cardiovascular complications a blood pressure of below 130 mmHg should be targeted. Hypertensive patients with an age above 80 years should be treated in the same way as younger hypertensive patients if they are otherwise healthy and functionally independent. On the other hand frail elderly patients could have an increased morbidity and mortality with intensive blood pressure control. In patients with resistant hypertension spironolactone was the most effective drug when given in addition to their baseline drugs (ACE-inhibitor/angiotensin receptor antagonist, calcium channel blocker and thiazide diuretic).

Schlüsselwörter

arterielle Hypertonie - Fitness - Blutdruckkontrolle

Keywords

systemic hypertension - physical fitness - blood pressure control

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