Hypertonie und Progression von Nierenerkrankungen - Konsequente Blutdruckeinstellung ist von essenzieller Bedeutung

Zusammenfassung

Bei nahezu allen renoparenchymatösen Erkrankungen, die zur chronischen Niereninsuffizienz führen, kann sich im Verlauf der Erkrankung eine arterielle Hypertonie multifaktorieller Genese entwickeln. Um die Progression einer chronischen bis hin zur terminalen Niereninsuffizienz zu verzögern, wird heute eine frühe und konsequente Einstellung des Bluthochdrucks gefordert (Zielblutdruckwert: < 130/80; bei Proteinurie über 1 g/Tag: < 125/75). Damit lässt sich aber nicht nur die Nierenfunktion langfristig erhalten, auch das kardiovaskuläre Risiko - das sich bei Patienten mit chronischer Niereninsuffizienz drastisch erhöht - ist so signifikant zu reduzieren. Je nach Grunderkrankung der Patienten werden heute ACE-Hemmer bzw. Angiotensin-Rezeptor-Antagonisten zur First-line-Therapie empfohlen. Denn beide Substanzklassen greifen direkt in das Renin-Angiotensin-Aldosteron-System (RAAS) ein, das bei Niereninsuffizienten inadäquat stimuliert ist. Sie regulieren nicht nur den Bluthochdruck, sondern scheinen zudem unabhängige renoprotektive Effekte aufzuweisen.

Summary

In virtually all diseases affecting the renal parenchyma that lead to chronic renal failure, arterial hypertension of multifactorial genesis may subsequently develop. With the aim of delaying progression of a chronic disease to terminal renal failure, early and rigorous control of hypertension is mandatory (target:< 130/80; in proteinurea > 1 g/day:< 125/75). With this approach not only can renal function be preserved over the longer term, but also the cardiovascular risk - which is dramatically elevated in patients with chronic renal insufficiency - can be significantly reduced. Depending on the underlying disease, ACE-inhibitors or angiotensin receptor antagonists are currently first-line treatment, since both of these classes of drug act directly on the renin-angiotensin-aldosterone system (RAAS), which is inappropriately stimulated in renal failure. Not only do these substances regulate the high blood pressure, but also appear to have independent renoprotective effects.

Key Words

chronic renal insufficiency - progression - proteinurea - hypertension - renin-angiotensin-aldosterone system - blood pressure control - ACE-inhibitors - angiotensin receptor antagonists

Literatur

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1 heart outcomes prevention study

2 modification of diet in renal disease

3 antihypertensive and lipid lowering treatment to prevent heart attack trial

4 african-american study of kidney disease

Anschrift des Verfassers