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DOI: 10.1055/s-0037-1618615
Differenzierte Pharmakotherapie beim adipösen Hypertoniker
Differential therapy of obesity-associated hypertensionPublication History
Publication Date:
21 December 2017 (online)
Zusammenfassung
Adipositas geht mit einer ca. 50%igen Prävalenz hypertoner Blutdruckwerte einher, die in Abhängigkeit vom Body-Mass-Index bis auf 80 Prozent ansteigt. Primäres Ziel ist eine durch Ernährungs-und Life-style-Modifikation erzielte, lang anhaltende Gewichtsreduktion, welche gegebenenfalls mit gewichtsreduzierenden Medikamenten zu ergänzen sind. Dabei senkt Orlistat zugleich den Blutdruck, was vom Sibutramin nur unter bestimmten Voraussetzungen in speziellen Situationen ausgeht. Die antihypertensive medikamentöse Differenzialtherapie sollte sich am pathophysiologischen Realisierungsmuster und den Begleit-und Folgeerkrankungen orientieren. Dabei genießen ACE-Hemmer (alternativ Angiotensin-Rezeptor-Blocker) in Kombination mit niedrig dosierten Diuretika die Priorität, gefolgt in der Kombination mit Kalziumantagonisten. Beta-Rezeptoren-Blocker sollten immer dann zum Einsatz kommen, wenn eindeutige kardiale Indikationen bestehen.
Summary
There is a 50% prevalence of obesity with arterial hypertension. This ratio can increase up to 80 %, depending on body mass index. The primary therapeutic aim is a reduction in weight by means of a balanced diet and life style modification, which can be augmented by weight reducing medication. Orlistat lowers blood pressure and body weight simultaneously, whereas sibutramine accomplishes this only under certain circumstances. Antihypertensive differential therapy should be focused on pathophysiology and concomitant and target organ disease. Thus ACE inhibitors (alternatively Angiotensin Receptor Blockers), in combination with low dose diuretics, should be preferentially administered, followed by calcium antagonists. Beta blockers should only be used if definite cardiac indications are present.
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