Zusammenfassung
Mit zunehmendem Lebensalter kommt es sowohl im Herzen als auch im Gefäßsystem zu strukturellen
Veränderungen, die die Entwicklung einer Herzinsuffizienz im Alter begünstigen. Eine
vermehrte Steifheit der Arterienwand führt dabei zu einer Zunahme des systolischen
arteriellen Drucks und der Pulswellengeschwindigkeit. Die resultierende Nachlasterhöhung
des Herzens trägt zur Myokardhypertrophie und zur neuroendokrinen Aktivierung im Alter
bei. Auf molekularer Ebene finden sich im alternden Herzen Veränderungen, die auch
bei manifester Herzinsuffizienz nachgewiesen werden können. Dies gilt insbesondere
für das sympathische Nervensystem. Die Therapie einer systolischen Herzinsuffizienz
bei älteren Patienten unterscheidet sich nicht von der jüngerer Patienten. Sämtliche
Substanzen, die bei jungen Menschen mit chronischer Herzinsuffizienz die Prognose
verbessern, sind auch im hohen Alter indiziert. Dies gilt für ACE-Hemmer bzw. Angiotensin-Rezeptorantagonisten
ebenso wie für Betablocker und Aldosteronantagonisten. Komorbiditäten sowie eine veränderte
Pharmakokinetik und Pharmakodynamik erfordern jedoch oftmals eine langsamere Therapieeinleitung,
eine individuelle Dosisanpassung sowie eine engmaschigere Überwachung älterer Patienten
Summary
Aging is associated with changes in cardiac and vascular structure, promoting the
development of heart failure. An increase in vascular stiffness leads to an increase
of systolic arterial pressure and pulse wave velocity. This augments the afterload
of the heart, which contributes to cardiac hypertrophy and neuroendocrine activation
in the elderly. On the molecular level the age-associated changes in the sympathetic
nervous system are similar to alterations that can be found in congestive heart failure.
Therapy of systolic heart failure does not differ between the elderly and younger
patients. All drugs which have shown to improve the prognosis of younger patients
are indicated in the elderly as well. This holds true for ACE-inhibitors or angiotensin
receptor antagonists, betablockers and aldosterone antagonists. However, comorbidities
as well as changes in the pharmacokinetics and pharmacodynamics might require a cautious
initiation of the therapy, an individual adjustment of the dosage and a thoroughly
monitoring of the elderly patients.
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Dr. Heiko Kilter
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes
66421 Homburg/Saar
Phone: 06841/1623000
Fax: 06841/1623434
Email: kilter@med-in.uni-sb.de
