Chronobiologie des Blutdrucks und Chronopharmakotherapie der arteriellen Hypertonie

Zusammenfassung

Der Blutdruck ist einem zirkadianen Rhythmus unterworfen, der zu einer nächtlichen Absenkung führt. Bei Diabetes, Niereninsuffizienz, linksventrikulärer Hypertrophie, Schlafapnoe, Schwangerschaftshypertonie und verschiedenen sekundären Hypertonieformen kann die nächtliche Absenkung aufgehoben oder in ihr Gegenteil verkehrt sein. Die Diagnostik erfolgt mit Hilfe der 24-h-Blutdruckmessung, die aber in der Praxis noch zu selten für eine klinische Einschätzung des Patienten und die Therapiesteuerung herangezogen wird. Eine Anpassung der Auswahl und des Einnahmezeitpunkts der antihypertensiven Pharmakotherapie im Hinblick auf den zirkadianen Rhythmus wirkt sich günstig auf die Blutdruckkontrolle und die kardiovaskuläre Morbidität aus. Das gilt vor allem für Patienten mit fehlendem nächtlichem Blutdruckabfall oder einem Anstieg, bei denen die abendliche Medikation zu einer Normalisierung des Blutdrucks und der Wiederherstellung der physiologischen zirkadianen Rhythmik beitragen kann. Die vorliegende Arbeit gibt einen aktuellen Überblick zur Chronopharmakotherapie der arteriellen Hypertonie und gibt praktische Empfehlungen zur Umsetzung dieser Erkenntnisse im klinischen Alltag.

Abstract

Arterial blood pressure is subject to a circadian rhythm that results in a fall of blood pressure during the night. In patients with diabetes, renal insufficiency, left-ventricular hypertrophy, sleep apnea, hypertension of pregnancy, and different forms of secondary hypertension a nocturnal fall of blood pressure is even abandoned or reverted. Diagnosis is made using 24-h blood pressure measurement, which is however used not frequently enough for a clinical assessment or adjustment of therapy. An adaption of the selection or the time of administration of antihypertensive drugs with respect to the circadian rhythm is beneficial to control blood pressure and reduce cardiovascular morbidity. This is particularly true for patients with an a non- or inverted dipping blood pressure pattern, in which the bedtime dosing may result in a normalization of blood pressure and restoration of a normal circadian rhythm. The present manuscript reviews the chronopharmacotherapy of arterial hypertension and grant practical recommendations for their translation into clinical practice.

Schlüsselwörter

Chronopharmakotherapie - 24-h-Blutdruck - Dipping - Mikroalbuminurie

Keywords

chronopharmacotherapy - 24-h-blood pressure - dipping - microalbuminuria

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