Zusammenfassung
Dieser Beitrag analysiert systematisch das wissenschaftliche Schrifttum zu Beeinträchtigungen
bei chronisch niedrigem Blutdruck und deren physiologischen Hintergrund. Subjektive
körperliche und psychische Beschwerden, vor allem in Form erhöhter Müdigkeitsneigung
und Antriebsschwäche, können als hinreichend objektiviert gelten. Daneben gibt es
eine breite Datenbasis zu kognitiven Leistungsdefiziten, vor allem in den Bereichen
Konzentration und Gedächtnis. Neuere Ergebnisse belegen zudem - entgegen der allgemeinen
Annahme - eine defizitäre zerebrale Durchblutungsregulation und eine damit verbundene
Minderperfusion des Gehirns bei Hypotonie. Die hieraus resultierende funktionelle
Beeinträchtigung des Gehirns spiegelt sich auch in EEG-Befunden wieder. Vor diesem
Hintergrund erscheint die geringe Bedeutung, die chronisch niedrigem Blutdruck in
Forschung und Praxis beigemessen wird, nicht gerechtfertigt.
Summary
The scientific literature on mental impairment in persons with chronically low blood
pressure (using WHO criteria) is systematically reviewed within its physiological
context. Subjective symptoms related to hypotension, especially tiredness and listlessness
have been adequately demonstrated. There are consistent findings demonstrating deficits
in cognitive functions, especially in the fields of concentration and memory. Additionally,
contrary to the current views, recent studies provide evidence for an impaired regulation
of cerebral blood flow and reduced cerebral perfusion. The resulting deficits in brain
function are also reflected in EEG findings. These findings indicate that the marginal
attention paid to chronic hypotension in research and clinical practice is no longer
justified.
Literatur
- 1
2003 European Society of Hypertension .
European Society of Cardiology guidelines for the management of arterial hypertension.
J Hypertens.
2003;
21
1011-1053
- 2
Aneja A, El-Atat F, McFarlane S I, Sowers J R.
Hypertension and obesity.
Rec Prog Horm Res.
2004;
59
169-205
- 3 Andreassi J L. Human behavior and physiological response. 4th edition London: Lawrence
Erlbaum 2000
- 4
Barrett-Connor E, Palinkas L A.
Low blood pressure and depression in men: a population based study.
Brit Med J.
1994;
308
446-449
- 5 Birbaumer N, Schmidt R F. Biologische Psychologie. 5. Auflage Berlin: Springer 2003
- 6 Cadalbert B. Die Psychophysiologie des niedrigen Blutdrucks: Kreislaufregulation,
Lebensgewohnheiten und Beschwerden. Frankfurt a. M.: Peter Lang 1997
- 7 Chillon J M, Baumbach G L. Autoregulation of cerebral blood flow. San Diego: Academic
Press In: Welch KMA, Caplan LR, Reis DJ, Siesjö BK, Weir B, editors. Primer on cerebrovascular
diseases 1995: 51-54
- 8
Costa M, Stegagno L, Schandry R, Bitti P ER.
Contingent negative variation and cognitive performance in hypotension.
Psychophysiology.
1998;
35
737-744
- 9
Craig A D.
Interoception: the sense of the physiological condition of the body.
Curr Opin Neurobiol.
2003;
13
500-505
- 10
Dahl A, Russell D, Nyberghansen R, Rootwelt K.
A comparison of regional cerebral blood-flow and middle cerebral-artery blood-flow
velocities - simultaneous measurements in healthy subjects.
J Cerebr Blood F Met.
1992;
12
1049-1054
- 11
Drummond J C.
The lower limit of autoregulation: time to revise our thinking?.
Anesthesiology.
1997;
86
1431-1433
- 12
Duschek S, Schandry R.
Functional transcranial Doppler sonography as a tool in psychophysiological research.
Psychophysiology.
2003;
40
436-454
- 13
Duschek S, Weisz N, Schandry R.
Reduced cognitive performance and prolonged reaction time accompany moderate hypotension.
Clin Auton Res.
2003;
13
427-432
- 14
Duschek S, Schandry R.
Cognitive performance and cerebral blood flow in essential hypotension.
Psychophysiology.
2004;
41
905-913
- 15
Duschek S, Schandry R.
Subjektive Beschwerden und kognitive Minderleistungen bei essentieller Hypotonie.
VT&VM.
2005;
26
5-31
- 16
Duschek S, Matthias E, Schandry R.
Essential hypotension is accompanied by deficits in attention and working memory.
Behav Med.
2005;
30
149-158
- 17
Duschek S, Meinhardt J, Schandry R.
Reduced cortical activity due to chronic low blood pressure: an EEG study.
Biol Psychol.
2006;
in press
- 18
Fehmann H C.
47-jähriger Mann mit „pure autonomic failure” und Perniziosa.
Dtsch Med Wochenschr.
2003;
128
1347-1350
- 19
Fredrikson M, Edmann G, Levander S E, Schalling D, Svensson J, Tuomisto M.
Electrodermal responsivity in young hypotensive and hypertensive men.
Psychophysiology.
1990;
27
649-655
- 20
Guo Z, Viitanen M, Fratiglioni L, Winblad B.
Low blood pressure and dementia in elderly people: the Kungsholmen project.
Brit Med J.
1996;
312
805-808
- 21
Harsanyi J, Kiss D.
Hypotonie in der Schwangerschaft.
ZBL Gynakol.
1985;
107
363-369
- 22
Heijer T, Skoog I, Oudkerk M. et al .
Association between blood pressure levels over time and brain atrophy in the elderly.
Neurobiol Aging.
2003;
24
307-313
- 23
Igler F O, Donegan J H, Hoo K C, Korns M E, Kampine J P.
Chronic localized hypotension and resetting of carotid sinus baroreceptors. Electrophysiological
and histological studies in the dog.
Circ Res.
1981;
49
649-654
- 24
Jorgensen L G, Perko G, Secher N H.
Regional cerebral-artery mean flow velocity and blood-flow during dynamic exercise
in humans.
J Appl Physiol.
1992;
73
1825-1830
- 25
Jorgensen L G, Perko M, Hanel B, Schroeder T V, Secher N H.
Middle cerebral-artery flow velocity and blood-flow during exercise and muscle ischemia
in humans.
J Appl Physiol.
1992;
72
1123-1132
- 26 Lacey J I. The visceral systems in psychology. American Psychological Association
In: Koch S, Leary DE, edidors. A century of psychology as science 1992: 721-736
- 27
Larsen F S, Olsen K S, Hansen B A, Paulson O B, Knudsen G M.
Transcranial Doppler is valid for determination of the lower limit of cerebral blood
flow autoregulation.
Stroke.
1994;
25
1985-1988
- 28
Lennox W G, Gibbs E L.
The blood flow in the brain and the leg of man and the changes induced by alternation
of blood gases.
J Clin Invest.
1932;
11
1155-1177
- 29
Mathias C J, Mallipeddi R, Bleasdale-Barr K.
Symptoms associated with orthostatic hypotension in pure autonomic failure and multiple
system atrophy.
J Neurol.
1999;
246
893-898
- 30
McCall M L.
Cerebral circulation and metabolism in toxemia of pregnancy. Observations on the effects
of Veratrum viride and apresoline (1-hydrazinophthala-zine).
Am J Obstet and Gynecol.
1953;
66
1015-1030
- 31
Morris M C, Scherr P A, Hebert L E. et al .
Association between blood pressure and cognitive function in a biracial community
population of older persons.
Neuroepidemiology.
2002;
21
123-130
- 32
Newell D W, Aaslid R, Lam A, Mayberg T S, Winn H R.
Comparison of flow and velocity during dynamic autoregulation testing in humans.
Stroke.
1994;
25
793-797
- 33
Ng P H, Walters W A.
The effect of chronic maternal hypotension during pregnancy.
Aust NZ J Obstet Gyn.
1992;
32
14-16
- 34
Olesen J.
Quantitative evaluation of normal and pathologic cerebral blood flow regulation to
perfusion pressure. Changes in man.
Arch Neurol-Chicago.
1973;
28
143-148
- 35
Olsen K S, Svenden L B, Larsen F S, Paulson O B.
Effect of labetalol on cerebral blood flow, oxygen metabolism and autoregulation in
healthy humans.
Br J Anaesth.
1995;
75
51-54
- 36
Paulson O B.
Blood-brain barrier, brain metabolism and cerebral blood flow.
Eur Neuropsychopharm.
2002;
12
495-501
- 37
Pilgrim J A, Stansfeld S, Marmot M.
Low blood pressure, low mood?.
Brit Med J.
1992;
304
75-78
- 38
Pollatos O, Schandry R.
Die Erfassung subjektiver Beschwerden bei der essentiellen Hypotonie mit der Hypotonie-Beschwerde-Liste
(HBL).
Praxis Klinische Verhaltensmedizin und Rehabilitation.
2002;
15
57-64
- 39
Richter-Heinrich E, Borys M, Sprung H, Läuter J.
Psychophysiologische Reaktionsprofile von Hypo- und Hypertonikern.
Deut Gesundheitswes.
1971;
32
1481-1489
- 40
Rosengren A, Tibblin G, Wilhelmsen L.
Low systolic blood pressure and self perceived wellbeing in middle aged men.
Brit Med J.
1993;
306
243-246
- 41
Schandry R.
Die Verbesserung der subjektiven Befindlichkeit bei orthostatischer Hypotonie unter
dem Einfluss blutdrucksteigernder Therapie.
Med Welt.
1999;
50
160-165
- 42 Schwab P. Der hypotonische Beschwerdenkomplex. Göttingen: Hogrefe 1992
- 43
Shaikh K A, Fischer J E, Steurer J, Bachmann L M.
Tests und Kriterien in der Diagnostik der chronischen Hypotonie - ein Systematic Review.
Schweiz Rundsch Med.
2001;
90
613-626
- 44
Stegagno L, Angrilli A, Costa M, Palomba D.
Deficit cognitivi e ipotensione arteriosa: UnŽ indagine cronopsycofisiologica.
Giornale Italiano di Psicologia.
1996;
23
837-859
- 45
Thefeld W, Stolzenberg H, Bellach B M.
Bundes-Gesundheitssurvey: Response, Zusammensetzung der Teilnehmer und Non-Responder-Analyse.
Gesundheitswesen.
1999;
61
S57-S61
- 46
Tonkin A.
Low blood pressure and low energy: (how) are they related?.
J Hypertens.
2004;
22
671-673
- 47
Villringer A, Dirnagl U.
Coupling of brain activity and cerebral blood flow: basis of functional neuroimaging.
Cerebrovas Brain Met.
1995;
7
240-276
- 48
v. Kerekjarto M.
Psychosomatische Beschwerden bei Hypotonie.
Der Internist.
1973;
14
521-542
- 49
Weisz N, Schandry R, Jacobs A, Mialet J, Duschek S.
Early contingent negative variation of the EEG and attentional flexibility are reduced
in hypotension.
Int J Psychophysiol.
2002;
45
253-260
- 50
Weiß R H, Donat K.
Arterielle Hypotonie.
Fortschr Med.
1982;
30
1396-1399
- 51
Wessely S, Nickson J, Cox B.
Symptoms of low blood pressure: a population study.
Brit Med J.
1990;
301
362-365
- 52 WHO .Arterial hypertension. Technical Report Series No. 628. Genova: World Health
Organisation 1978
Dipl.-Psych. Dr. Stefan Duschek
Ludwig-Maximilians-Universität München, Department Psychologie
Leopoldstraße 13
80802 München
Phone: 089/21805297
Fax: 089/21805233
Email: duschek@psy.uni-muenchen.de
