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DOI: 10.1055/s-2004-826895
© Georg Thieme Verlag Stuttgart · New York
ACE-Hemmertherapie bis ans Lebensende?
Kardio- und vaskuloprotektive Mechanismen durch Blockade des Renin-Angiotensin-SystemsTreatment with ACE inhibitors until the end of life? Cardiovascular-protective blockade of the renin-angiotensin systemPublikationsverlauf
eingereicht: 16.2.2004
akzeptiert: 1.4.2004
Publikationsdatum:
21. Juli 2004 (online)

Zahlreiche Studien haben günstige Wirkungen von ACE-Hemmern bei hypertensiven Patienten bezüglich der kardiovaskulär bedingten Sterblichkeit und Gesamtmortalität demonstriert [14] [38]. In der Sekundärprävention der Atherosklerose und der Herzinsuffizienz nehmen ACE-Hemmer eine wichtige Rolle ein, da sie die Lebenserwartung signifikant verbessern. In der HOPE-Studie [43] reduzierte Ramipril bei kardiovaskulären Hochrisikopatienten ohne Herzinsuffizienz das Risiko für den kombinierten primären Endpunkt um 25 % (95 % CI 12-36, p = 0,0004), für Myokardinfarkt um 22 % [6-36], für Schlaganfall um 33 % (10-50) sowie für Gesamtmortalität um 24 % [8-37]. Dabei war die Risikoreduktion ausgeprägter als durch die Blutdrucksenkung zu erwarten gewesen wäre. Neben einer Verbesserung der Hämodynamik wird als Ursache hierfür die effektive Hemmung neuroendokriner Systeme diskutiert. Darüber hinaus haben ACE-Hemmer antiproliferative, endothelprotektive und antiatherosklerotische Effekte, die für die Reduktion von Morbidität und Letalität mitverantwortlich sind [4] [21].
Diese Erkenntnisse legen den Schluss nahe, dass eine einmal initiierte ACE-Hemmertherapie bis an das Lebensende fortgeführt werden sollte. Der steigende Kostendruck im Gesundheitswesen und physiologische Veränderungen mit zunehmendem Alter sowie die Tatsache, dass Studienpopulationen nur selten alte und hochaltrige Patienten repräsentieren, verlangen eine differenziertere Sichtweise. In der folgenden Übersicht wird die derzeitige Studienlage bezüglich einer ACE-Hemmertherapie bis ins hohe Lebensalter dargestellt und auf eine altersspezifische Differentialtherapie bei der arteriellen Hypertonie und Herzinsuffizienz mit ACE-Hemmern eingegangen.
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Dr. Nikos Werner
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes
66421 Homburg-Saar
Telefon: 06841/1623436
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eMail: werner@med-in.uni-sb.de