Antihypertensive Chronotherapie Chronopathologie renaler Hochdruckformen

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. Bei der renalen Hypertonie sind der nächtliche Blutdruck und der Tag-Nacht-Rhythmus von besonderem Interesse. Daher sind die chronopharmakologischen Aspekte der antihypertensiven Therapie, also die Berücksichtigung von Pharmakokinetik und -dynamik in Abhängigkeit von der Tageszeit, der Applikation und der Wirkdauer der Substanzen, von großer klinischer Bedeutung bei Patienten mit renalen Hochdruckformen. 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 Blutdruckabsenkung („super 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 ambulanter Blutdrucklangzeitmessung möglich. Dieses Vorgehen beschreibt die antihypertensive Chronotherapie.

The chronopathology of hypertension describes the variations in the course of blood pressure regulation over time, their nature, causes, diagnostic and prognostic significance and therapeutic consequences. In renal hypertension, nocturnal blood pressure and the day/night rhythm are of particular interest. For this reason, the chronopharmacological aspects of antihypertensive treatment – that is, the consideration of the pharmacokinetics and -dynamics during the course of the day, the application and duration of effect of medications – are of considerable clinical significance in patients with renal forms of hypertension. Important therapeutic aims in high-risk patients with inadequate nocturnal blood pressure drop (“non-dippers”) or inversion of the blood pressure rhythm (“inverted dippers”) are nocturnal decrease in blood pressure and the establishment of a normal circadian rhythm. However, to avoid nightly ischaemia, evening medication in patients experiencing marked spontaneous blood pressure drop (“super dipper”) is inadmissible. This applies in particular to elderly patients and to those with cardiovascular disease. Here, individual management of antihypertensive medication, and the regulation of administration intervals is possible only via ambulatory blood pressure measurement. This approach is described as antihypertensive chronotherapy.

hypertension - chronotherapy - chronopharmacology - blood pressure rhythm

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