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Antihypertensive medikamentöse Therapie bei Diabetes mellitus

  • P. T. Sawicki

Zusammenfassung

Studien aus allen Teilen der Welt zeigen übereinstimmend eine erhöhte Sterblichkeitsrate bei Patienten mit juvenilem (Typ 1) Diabetes mellitus. Eine dänische Langzeitstudie, in der 1030 Patienten mit Typ-1-Diabetes-mellitus über 30–50 Jahre verfolgt wurden, zeigte, daß die extrem hohe Exzeßmortalität nur bei den Patienten vorlag, die während ihrer Diabeteserkrankung eine persistierende Proteinuric entwickelt hatten [5]. Dagegen hatten Patienten ohne diabetische Nephropathie eine nahezu normale Lebenserwartung. Während akute metabolische Komplikationen und Infektionen die häufigsten Todesursachen von Patienten mit kurzer Diabetesdauer sind, sind bei langer Diabetesdauer zerebro- und kardiovaskuläre Komplikationen fur 2/3 aller Todesfälle verantwortlich [30] (s. Übersicht). Konventionelle antihypertensive Therapie einschließlich von β-Blocker und Diuretika senkt nicht nur bei essentieller Hypertonie, sondern auch bei hypertonen Patienten mit Diabetes mellitus und Nephropathie sehr effektiv die Mortalität und Morbidität, vor allem durch eine Reduktion des Myokardinfarkt- und des Schlaganfallrisikos. In 2 Studien von Mathiesen u. Parving (Übersicht in [26]), die erstmalig eine Reduktion der Mortalität durch antihypertensive Therapie bei diabetischer Nephropathie zeigten, wurden als Antihypertensiva der ersten Wahl Diuretika und β-Blocker eingesetzt. Unter dieser Therapie ist es gelungen, die Mortalität nach 10jähriger Dauer der Nephropathie von etwa 80% auf weniger als 20% zu senken (Abb. 1).

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© Springer-Verlag Berlin Heidelberg 1997

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  • P. T. Sawicki

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