Adipositas-assoziierte Hypertonie

Zusammenfassung

Adipositas erhöht das Risiko, hypertensive Blutdruckwerte zu entwickeln. Hypertonie ist einer der bedeutendsten Risikofaktoren für Gefäßerkrankungen und spielt eine besondere Rolle im Herz, in den Nieren und im Gehirn. Die Initiierung nichtmedikamentöser und medikamentöser blutdrucksenkender Maßnahmen hängt letztlich von der Blutdruckhöhe und vom kardiovaskulären Gesamtrisiko ab. Der Nutzen aller nichtmedikamentösen und medikamentösen blutdrucksenkenden Maßnahmen hängt eher vom Ausmaß der Blutdruckreduktion ab, vermutlich nicht von den Maßnahmen selber. Eine gut verträgliche Kombinationstherapie mit mehreren blutdrucksenkenden Arzneimitteln und nichtmedikamentösen Maßnahmen ist die Therapie der Wahl. In dieser Übersicht werden die wichtigsten Leitlinienempfehlungen zur Therapie zusammengefasst, spezielle Implikationen für Patient*innen mit adipositas-assoziierter Hypertonie lassen sich – auch mangels geeigneter Studien – daraus aber nicht ableiten.

Abstract

Obesity increases the risk to develop hypertension. Hypertension is one of the most important risk factors for the development of vascular disease. Major target organs of deleterious hypertensive effects in the vasculature are the heart, the kidneys, and the brain. Initiation of antihypertensive treatment by lifestyle changes and antihypertensive drugs is dependent on actual blood pressure measurements and total cardiovascular risk. Beneficial blood pressure lowering effects depend more on the total decrease in systolic and diastolic blood pressure values than on the nature of the intervention. A well tolerated combination of drug treatment and suitable lifestyle changes is the best choice for most patients. This review summarizes the most important recommendations from current hypertension guidelines. From these guidelines, special actions for the patient with obesity-associated hypertension cannot be recommended, not the least because suitable randomized studies are missing.

Schlüsselwörter

Hypertonie - Blutdruckmessung - Adipositas - Gewichtsreduktion - Kochsalzreduktion - Antihypertensiva

Key words

hypertension - blood pressure measurement - obesity - body weight reduction - sodium restriction - antihypertensive drugs

Publication History

Article published online:
14 June 2023

• Literatur

• 1 Mikhail N, Golub MS, Tuck ML.. Obesity and hypertension. Prog Cardiovasc Dis 1999; 42: 39-58
• 2 Piepoli MF, Hoes A, Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovasular Disease Prevention in Clinical Practice. Eur Heart J 2016; 37: 2315-2381
• 3 Jordan J, Yumuk V, Schlaich MP. et al. Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and difficult to treat arterial hypertension. J Hypertens 2012; 30: 1047-1055
• 4 Lambert EA, Esler MD, Schlaich MP. et al. Obesity-Associated Organ Damage and Sympathetic Nervous Activity. Hypertension 2019; 73: 1150-1159
• 5 Sharma AM, Engeli S.. Obesity and the renin- angiotensin-aldosterone system. Expert Rev Endocrinol Metab 2006; 1: 255-264
• 6 Jordan J, Birkenfeld AL, Melander O. et al. Natriuretic Peptides in Cardiovascular and Metabolic Crosstalk: Implications for Hypertension Management. Hypertension 2018; 72: 270-276
• 7 Hall JE, do Carmo JM, da Silva AA. et al. Obesity, kidney dysfunction and hypertension: mechanistic links. Nat Rev Nephrol 2019; 15: 367-385
• 8 Deutsche Gesellschaft für Kardiologie – Herz-und Kreislaufforschung e.V. (2019) / Deutsche Hochdruckliga e.V. ESC/ESH Pocket Guidelines. Management der arteriellen Hypertonie. Version 2018. Im Internet: https://leitlinien.dgk.org/2019/pocket-leitlinie-management-der-arteriellen-hypertonie-2/; Stand: 22.05.2023
• 9 Williams B, Mancia G, Spiering W. et al. ESC Scientific Document Group 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021-3104
• 10 Konsultationsfassung NVL Hypertonie. Im Internet: https://www.leitlinien.de/themen/hypertonie; Stand: 22.05.2023
• 11 Sarganas G, Neuhauser HK.. Untreated, uncontrolled, and apparent resistant hypertension: Results of the German Health Examination Survey 2008-2011. J Clin Hypertens 2016; 18: 1146-1154
• 12 Ge L, Sadeghirad B, Ball GD. et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials. BMJ 2020; 369: m696
• 13 Straznicky N, Grassi G, Esler M. et al. European Society of Hypertension Working Group on Obesity Antihypertensive effects of weight loss: myth or reality?. J Hypertens 2010; 28: 637-643
• 14 Aucott L, Poobalan A, Smith WC. et al. Effects of weight loss in overweight/obese individuals and long-term hypertension outcomes: a systematic review. Hypertension 2005; 45: 1035-1041
• 15 Neter JE, Stam BE, Kok FJ. et al. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003; 42: 878-884
• 16 Ayinapudi K, Samson R, Le Jemtel TH. et al. Weight Reduction for Obesity-Induced Heart Failure with Preserved Ejection Fraction. Curr Hypertens Rep 2020; 22: 47
• 17 Iqbal J, Wu HX, Hu N. et al. Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with obesity without diabetes mellitus—a systematic review and meta-analysis of randomized control trials. Obes Rev 2022; 23: e13435
• 18 Samson R, Ayinapudi K, Le Jemtel TH. et al. Obesity, Hypertension, and Bariatric Surgery. Curr Hypertens Rep 2020; 22: 46
• 19 Hofso D, Nordstrand N, Johnson LK. et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol 2010; 163: 735-745
• 20 Sjostrom CD, Lystig T, Lindroos AK. Impact of weight change, secular trends and ageing on cardiovascular risk factors: 10-year experiences from the SOS study. Int J Obes (Lond) 2011; 35: 1413-1420
• 21 Sjostrom L, Peltonen M, Jacobson P. et al. Bariatric surgery and long-term cardiovascular events. JAMA 2012; 307: 56-65
• 22 Alghamdi S, Mirghani H, Alhazmi K. et al. Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy effects on obesity comorbidities: A systematic review and meta-analysis. Front Surg 2022; 9: 953804