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Nephroprotektion durch Antihypertensiva

  • J. Jacobi
  • Roland E. Schmieder

Zusammenfassung

Trotz enormer technischer Fortschritte und optimierter Therapiemöglichkeiten stellt die chronisch progrediente Niereninsuffizienz ein zunehmendes globales, sozioökonomisches und medizinisches Problem dar, da Erkrankungshäufigkeit und Sterblichkeitsrate stetig ansteigen. Die arterielle Hypertonie ist nach dem Diabetes mellitus die zweithäufigste Ursache für ein chronisches Nierenversagen. In Anbetracht der Tatsache, daß beide Erkrankungen effektiv behandelt werden können, stellt sich die Frage nach einer Verbesserung und intensiveren Ausschöpfung der zur Verfügung stehenden Behandlungsstrategien. In diesem Zusammenhang konnte gezeigt werden, daß eine medikamentöse Blutdrucksenkung unterhalb des klassischen Zielwerts von 140/90 mmHg zu einer Verlangsamung der Progression des Nierenfunktionsverlusts beiträgt. Dieser Zielblutdruck kann primär durch alle derzeit verfügbaren Hochdruckmedikamente erreicht werden. Der wesentliche Unterschied zwischen den Vertretern der verschiedenen Substanzklassen begründet sich in den von der Blutdrucksenkung unabhängigen nephroprotektiven Eigenschaften. Insbesondere die Klasse der ACE-Hemmer und Angiotensin II-AT1-Rezeptorantagonisten führen blutdruckunabhängig zu einer günstigen Beeinflussung der renalen Hämodynamik und der Nierenfunktion, während Diuretika und ß-Blocker in äquipotent blutdrucksenkender Dosis die Nierenfunktion eher verschlechtem. Die Datenlage zur nephroprotektiven Potenz der Kalziumantagonisten ist kontrovers, insbesondere wenn man nach harten Endpunkten sucht. Für die ACE-Hemmer dagegen gibt es mehrere prospektive Studien, in denen eine über die Blutdrucksenkung hinausgehende Verhinderung des Nierentodes dokumentiert wurde. Inwieweit sich Angiotensin II-AT1-Rezeptorantagonisten in ihrer Langzeitwirkung auf die Nierenfunktion von der Klasse der ACE-Hemmer unterscheiden, wird sich erst im Rahmen placebokontrollierter, prospektiver Langzeitstudien erweisen.

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© Dr. Dietrich Steinkopff Verlag GmbH & Co. KG, Darmstadt 1999

Authors and Affiliations

  • J. Jacobi
    • 1
  • Roland E. Schmieder
    • 1
    • 2
  1. 1.Medizinische Klinik IV/4Universität Erlangen-NürnbergDeutschland
  2. 2.Medizinische Klinik IV/4Universität von Erlangen-NürnbergNürnbergDeutschland

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