Zusammenfassung
Die Behandlung der Hypertonie ist im Sinne der Primärprävention eine hocheffiziente Maßnahme zur Reduktion von kardiovaskulären Ereignissen. Der Therapieerfolg wird in erster Linie durch die erzielte Blutdrucksenkung geprägt. Bei Begleiterkrankungen des Patienten ist die Auswahl der Antihypertensiva kritisch abzuwägen. Denn einige Medikamentengruppen haben neben ihrer blutdrucksenkenden Wirkung auch einen direkten Effekt auf die Prognose der Begleiterkrankung. Diesen Zusatzeffekt gilt es synergistisch mitzuerfassen. Nur so kann die optimale Therapiestrategie für jeden einzelnen Patienten definiert werden. Diese Übersicht beschreibt die möglichen Begleiterkrankungen bei Hypertonie, die einen Einfluss auf die Auswahl von Antihypertensiva haben können. Begleiterkrankungen können aber auch Kontraindikationen für einzelne Medikamente darstellen und sind somit auch unter diesem Aspekt in die differentialtherapeutischen Überlegungen einzubeziehen.
Summary
The treatment of hypertension in the sense of primary prevention is a highly effective measure for the reduction of cardiovascular events. The success of therapy is, in the first instance, determined by the extent to which the elevated blood pressure is lowered. In the presence of concomitant diseases, the choice of antihypertensives must be considered with care, since a number of classes of drugs have a direct impact on the prognosis of comorbidity in addition to their blood pressure-lowering effect. This additional synergistic action must be taken into account. Only in this way is it possible to define an optimal therapeutic strategy for each individual patient. The present overview describes the possible comorbidities accompanying hypertension that may impact on the choice of the appropriate antihypertensive agent. Comorbidities may also represent contraindications for individual drugs, and must thus be taken into account when considering differential therapeutic measures.
Literatur
-
1
Agodoa LY, Appel L, Bakris GL. et al. .
Effect of ramipril vs amlodipin on renal outcomes in hypertensive nephrosclerosis.
JAMA.
2001;
285
2719-272
-
2
Barnett AH, Bain SC, Bouter P. et al. .
Angiotensin-receptor blockade versus converting-enzyme inhibition in type-2 diabetes and nephropathy.
NEJM.
351;
2004
1952-1961
-
3
Blood pressure Lowering Treatment Trialists Collaboration. .
Effects of different blood-pressure-lowering regimes on major cardiovascular events: results of prospectively-designed overviews of randomised trials.
Lancet.
2003;
362
1527-1535
-
4
Bönner G, Schmieder R, Chrosch R, Weidinger G.
Effect of bunazosin and atenolol on glucose metabolism in obese, non diabetic patients with primary hypertension.
Cardiovascular Drugs and Therapy.
1997;
11
21-26
-
5
Brenner BM, Cooper ME, de D Zeeuw. et al. .
Effects of Losartan on Renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.
N Engl J Med.
2001;
345
861-869
-
6
Brown MJ, Palmer CR, Castaigne A. et al. .
Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT).
Lancet.
2000;
358
366-372
-
7
Chobanian AV. et al. .
The seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
JAMA.
2003;
289
2560-2572
-
8
CIBIS Investigators and Committees .
A randomized trial of beta-blockade in heart failure: the Cardiac Insufficiency Bisoprolol Study (CIBIS).
Circulation.
1994;
90
1765-1773
-
9
Cohn JN, Tognoni G.
A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure.
NEJM.
2001;
345
1667-1675
-
10
Dageneis GR, Yusuf S, Bourassa MG. et al. .
on behalf of the HOPE investigators. Effects of ramipril on coronary events in high-risk persons.
Circulation.
2001;
104
522-526
-
11
Dahlöf B, Devereux RB, Kjeldsen S. et al. .
Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol.
Lancet.
2002;
359
995-1003
-
12
DeBacker G. et al. .
European guidelines on cardiovascular disease prevention in clinical practice.
Eur J Cardiovasc Prevention Rehabilitation.
2003;
10
1-78
-
13 Deutsche Hypertonie Gesellschaft/ Deutsche Liga zur Bekämpfung des hohen Blutdrucks. .Leitlinien für die Prävention, Erkennung, Diagnostik und Therapie der arteriellen Hypertonie. AWMF online Register 046/001, Entw.-Stufe 2003
-
14
Estacio RO. et al. .
The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non insulin dependent diabetes and hypertension.
N Engl J Med.
1998;
338
645-652
-
15
Fagard RH.
The ALLHAT trial: strengths and limitations.
J Hypertens.
2003;
21
229-232
-
16
Gress TW, Nieto FJ, Shahar E. et al. .
Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus.
N Engl J Med.
2000;
342
905-912
-
17
Guidelines Committee .
2003 European Society of Hypertension - European Society of Cardiology guidelines for the management of arterial hypertension.
J Hypertens.
2003;
21
1011-1053
-
18
Hansson L, Lindholm LH, Niskanen L. et al. .
Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial.
Lancet.
1999;
353
611-616
-
19
Heart Outcome Prevention Evaluation (HOPE) Study investigators .
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy.
Lancet.
2000;
355
253-259
2000;
860
-
20
Jacob S, Rett K, Wicklmayr M. et al. .
Differential effect of chronic treatment with two beta-blocking agents on insulin sensitivity: the carvedilol-metoprolol study.
J Hypertens.
1996;
14
489-494
-
21
Julius S, Kjeldsen SE, Weber M. et al. .
Outcomes in hypertensive patients at high cardiovascular risk treated with regimes based on valsartan or amlodipine: the VALUE randomized trial.
Lancet.
2004;
363
2022-2031
-
22
Lewis EJ, Hunsicker LG, Rhode RP.
The effects of angiotensin-converting-enzyme inhibition on diabetic nephropathy.
N Engl J Med.
1993;
329
1456-1462
-
23
Lewis EJ, Hunsicker LG, Clarke WR. et al. .
Renoprotective effects of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.
N Engl J Med.
2001;
345
851-860
-
24
Lindholm LH, Ibsen H, Dahlöf B. et al. .
Cardiovascular morbidity and mortality in patients with diabetes in the losartan intervention for endpoints reduction in hypertension study (LIFE): a randomised trial against atenolol.
Lancet.
2002;
359
1004-1010
-
25
MRC Working Party .
Medical Research Council trial of treatment of hypertension in older adults: Principal results.
Br Med J.
1992;
304
405-412
-
26
Nakao N, Yoshimura A, Morita H. et al. .
Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial.
Lancet.
2003;
361
117-124
-
27
Packer M, O`Connor CM, Ghali JK. et al. .
Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine in Survival Evaluation Group.
NEJM.
1996;
335
1107-1114
-
28
Packer M, Coats AJ, Fowler MB. et al. .
Effect of carvedilol on survival in severe chronic heart failure.
NEJM.
2001;
344
1651-1658
-
29
Parving HH, Lehnert H, Bröchner-Mortensen J. et al. .
The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes.
N Engl J Med.
2001;
345
870-878
-
30
PATS Collaborative Group .
Post-stroke antihypertensive treatment study.
Clin Med J.
1995;
108
710-717
-
31
Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS.
Regression of microalbuminuria in type-1 diabetes.
New Engl J Med.
2003;
348
2285-2293
-
32
Pfeffer MA, Braunwald E, Moye LA. et al. .
Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction.
NEJM.
1992;
327
669-677
-
33
Pfeffer MA, Swedberg K, Granger CB. et al. .
for the CHARM investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-overall programme.
Lancet.
2003;
362
759-766
-
34
Pitt B, Zannad F, Remme WJ. et al. .
The effect of spironolactone on morbidity and mortality in patients with severe heart failure.
NEJM.
1999;
341
709-717
-
35
Pitt B, Poole-Wilson PA, Segal R. et al. .
Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: a randomized trial - the Losartan Heart Failure Survival Study ELITE II.
Lancet.
2000;
355
1582-1587
-
36
Pitt B, Remme WJ, Zannad F. et al. .
Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction.
NEJM.
2003;
348
1309-1321
-
37
PROGRESS Collaborative Study Group .
Randomised trial of perindopril based blood-pressure-lowering regimen among 6108 individuals with previous stroke or transient ischemic attack.
Lancet.
2001;
358
1033-1041
-
38
Ritz E, Nowicki M, Orth S, Fliser D, Wagner J.
ACE-Hemmer-Therapie bei Patienten mit Nierenerkrankungen. In: Bönner G, Rahn KH (eds). ACE-Hemmer Handbuch.
Stuttgart: Schattauer Verlag.
1994;
409-430
-
39 Scholze J. Hypertonie: Risikokonstellation und Begleiterkrankungen. Berlin, Wien: Blackwell Wissenschafts-Verlag 2003
-
40
Schrier RW, Estacio RO, Esler A, Mehler P.
Effects of aggressive blood pressure control in normotensive type-2 diabetic patients on albuminuria, retinopathy and stroke.
Kidney Int.
2002;
61
1086-1097
-
41
Tepper D.
Frontiers in congestive heart failure: effect of metoprolol CR/XL in chronic heart failure.
Congest Heart Fail.
1999;
5
184-185
-
42
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group .
Major cardiovascular events in hypertensive patients randomised to doxazosin vs chlorthalidone. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
JAMA.
2000;
283
1967-1975
-
43
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group .
Major outcomes in high-risk hypertensive patients randomised to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering treatment to Prevent Heart Attack Trial (ALLHAT).
JAMA.
2002;
288
2981-2997
-
44
The CAPPP Group .
The Captopril Prevention Project (CAPPP): a prospective intervention trial of angiotensin-converting enzyme inhibition in the treatment of hypertension.
J Hypertens.
1990;
8
985-990
-
45
The European Trial on Reduction of cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators .
Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo-controlled, multicentre trial (the EUROPA study).
Lancet.
2003;
362
782-788
-
46
The GISEN Group .
Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy.
Lancet.
1997;
349
1857-1863
-
47
The HOPE Study Investigators .
The Heart Outcomes Prevention Evaluation (HOPE) Study.
Can J Cardiol.
1996;
12
127-137
-
48
The MRC Working Party .
Medical Research Council trial of treatment of hypertension in older adults: principal results.
BMJ.
1992;
304
405
-
49
The PEACE Trial Investigators .
Angiotensin-converting-enzyme inhibition in stable coronary disease.
NEJM.
2004;
351
2058-2068
-
50
The SOLVD Investigators .
Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.
NEJM.
1991;
325
293-302
-
51
UK Prospective Diabetes Study Group .
Tight blood pressure control and risk on macrovascular and microvascular complications in type-2 diabetes: UKPDS 38.
BMJ.
1998;
317
703-713
-
52
UK Prospective Diabetes Study Group .
Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type-2 diabetes: UKPDS 39.
BMJ.
1998;
317
713-721
-
53
Wing LMH, Reid CM, Ryan P. et al. .
A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly (ANBP-2).
NEJ.
2003;
348
583-592
-
54
Zanchetti A, Bond MG, Hennig M. et al. .
Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis: Principal results of the European lacidipine study on atherosclerosis (ELSA), a randomised, double-blind, long-term trial.
Circulation.
2002;
108
2422-2427
Anschrift des Verfassers
Prof. Dr. med. Gerd Bönner
Ärztlicher Direktor, Klinik Lazariterhof/Baden-Privatklinik
MEDIAN Kliniken Bad Krozingen
Herbert-Hellmann-Allee 44
79189 Bad Krozingen
