Chronopathologie der Hypertonie und antihypertensive Chronotherapie

Zusammenfassung

Die Chronopathologie der Hypertonie beschreibt die verschiedenen Phänomene der Normabweichung im zeitlichen Verlauf der Blutdruckregulation, ihre Charakteristika, die Ursachen, die diagnostische und prognostische Bedeutung, sowie die therapeutischen Konsequenzen. Dabei sind der nächtliche Blutdruck und der Tag-Nacht-Rhythmus von besonderem Interesse. In diesem Zusammenhang sind die chronopharmakologischen Aspekte der Antihypertensiva, d. h. die Berücksichtigung von Pharmakokinetik und -dynamik in Abhängigkeit von der Tageszeit, der Applikation und der Wirkdauer der Substanz von großer klinischer Bedeutung.

Insbesondere eine nächtliche Blutdrucksenkung und die Wiederherstellung eines normalen zirkadianen Rhythmus sind wichtige Therapieziele bei Risikopatienten mit unzureichender Nachtabsenkung (non-dipper) oder einer Inversion des Blutdruckrhythmus (inverted dipper). Andererseits verbietet sich eine abendliche Dosierung bei Patienten mit spontan ausgeprägter nächtlicher Blutdrucksenkung (extreme dipper), um nächtliche Ischämien zu vermeiden. Dies gilt insbesondere für ältere Patienten und für Patienten mit kardiovaskulären Erkrankungen. Bei diesen Patienten sind eine individuelle Steuerung der antihypertensiven Medikation und eine Anpassung der Dosierungsintervalle nur mittels ABDM möglich. Dieses Vorgehen beschreibt die antihypertensive Chronotherapie.

Abstract

Chronopathology of hypertension describes deviations in blood pressure over time together with the characteristics, causes, and diagnostic and prognostic aspects of these deviations, and the implications for antihypertensive therapy. Nocturnal blood pressure and the circadian rhythm of blood pressure are of particular interest. Chronopharmacological aspects of antihypertensive medication, i. e. the changes in pharmacokinetics and -dynamics depending on the time of day, the administration of medication and the duration of its effectiveness, are clinically very important.

Ensuring a nocturnal fall in blood pressure and re-establishing a normal circadian rhythm are important therapeutic goals for high risk patients with an insufficient nocturnal drop in blood pressure (non-dipper) or an inversion of blood pressure rhythm (inverted dipper). In contrast, to prevent nocturnal ischemia, evening dosing of antihypertensive medication is contraindicated in patients with an extreme nocturnal fall in blood pressure (extreme dipper). This is particularly relevant for elderly patients and for patients with cardiovascular disease. Antihypertensive chronotherapy is indicated in these patients, i.e., the individual guidance of antihypertensive medication and adjustment of dosing intervals to take account of the circadian rhythm using ambulatory blood pressure monitoring (ABPM).

Schlüsselwörter

Chronopathologie - arterielle Hypertonie - antihypertensive Chronotherapie

Key words

hypertensive chronopathology - antihypertensive chronotherapy

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