Primäre und sekundäre arterielle Hypertonie – Update 2017

 

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Bedeutung und Epidemiologie der Hypertonie Die arterielle Hypertonie bleibt trotz aller Aufklärungsarbeit und Therapiemöglichkeiten der wichtigste Risikofaktor für eine erhöhte Sterblichkeit, für ischämische apoplektische Insulte und zerebrale Blutungen.

Obstruktive Schlafapnoe und Hypertonie Eine Störung der Atmung im REM-Schlaf hat stärkeren Einfluss auf Pathomechanismen und die Entwicklung einer arteriellen Hypertonie am Tage als obstruktive Apnoen im Non-REM-Schlaf. Möglicherweise profitieren Schlafapnoe-Patienten mit einer therapierefraktären Hypertonie von einer renalen Denervation.

Zielblutdruck Eine erneute kritische Analyse der SPRINT-Studie lässt v. a. wegen Besonderheiten der Blutdruckmesstechnik keine allgemeinen Empfehlungen zu niedrigeren Zielblutdruckwerten zu als in den europäischen Leitlinien angegeben. Auch die HOPE-3-Studie belegt weder niedrigere Zielblutdruckwerte noch einen Nutzen einer Polypill bei Patienten mit moderatem kardiovaskulärem Risiko.

Interventionelle Hochdrucktherapie Es gibt weiterhin keine Daten aus randomisierten doppelblinden Studien einschl. Schein-Intervention, die einen Zusatznutzen der renalen Denervierung belegen. Was die Barorezeptorstimulation anbetrifft, so gibt es einige interessante neue Daten bei Patienten mit therapierefraktärer Hypertonie, allerdings ebenfalls keine neuen randomisierten doppelblinden Studien mit SHAM-Intervention.

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