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Therapie kardiovaskulärer Erkrankungen

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Praktische Arzneitherapie

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Zusammenfassung

Diese Medikamentengruppe wird eingesetzt, um erhöhte Blutdruckwerte (>140/90 mg/Hg) zu senken bzw. zu normalisieren. Es handelt sich bei der medikamentösen antihypertensiven Behandlung in der Regel um eine symptomatische, aber nicht um eine kausale Therapie. Die Kooperation der Patienten (Compliance) ist Voraussetzung, um auf lange Sicht die Hypertonie zu kontrollieren und deren kardiovaskuläre und renale Komplikationen zu verhindern. Beginn, Absetzen oder die Dosisanpassung einer antihypertensiven Therapie sollten niemals ohne ärztliche Überwachung erfolgen, wobei Arzt und Patient auf rechtzeitige Wiederverschreibung der Medikation achten müssen (Vermeidung eines „Rebound-Phänomens“). Arzneimittelwechselwirkungen von Antihypertensiva mit gleichzeitig verabreichten Pharmaka sind zahlreich und können zur Wirkabschwächung (z. B. nichtsteroidale Antirheumatika) oder zur Wirkverstärkung der blutdrucksenkenden Medikamente führen (z. B. bei gleichzeitiger Gabe weiterer antihypertensiver Substanzen, von Nitraten oder Neuroleptika). An Nebenwirkungen verursachen Antihypertensiva häufig Müdigkeit, Schwindel und Benommenheit, sodass die Fahrtüchtigkeit und Tätigkeiten, die erhöhte geistige Aufmerksamkeit erfordern, beeinträchtigt werden können. Gleichzeitiger Alkoholgenuss bzw. die Einnahme sedierender Medikamente kann die o. g. unerwünschten Effekte verstärken, insbesondere können diese nach dem Aufrichten aus sitzender oder liegender Position auftreten. Die ganz überwiegende Anzahl der Hypertoniker hat eine leichte bis mittelschwere Form der Hypertonie. Diese kann in der Mehrzahl mit diätetischer Salzrestriktion, z. B. Vermeidung stark salzhaltiger Nahrungsmittel wie Pökelfleisch (Kassler), von gesalzenen Nüssen, Büchsennahrung, und Minimierung der Salzzugabe beim Kochen sowie einem Diuretikum in niedriger bis mittlerer Dosierung (z. B. Chlortalidon 25–50 mg/Tag) gut behandelt werden. Da zahlreiche andere Antihypertensiva eine Natriumretention bewirken, können Diuretika in niedriger Dosis auch zusätzlich gegeben werden. Die Kombination aus einem Diuretikum und Beta-Rezeptorenblocker, falls das Diuretikum allein nicht ausreichend wirksam ist, hat sich bewährt. Spezielle Patientengruppen:

  • Hypertoniker mit Diabetes mellitus: Diese Patienten sind vorzugsweise mit ACE-Hemmern zu therapieren, weil dadurch das Fortschreiten der diabetischen Nephropathie verzögert wird. Sie sollten keine Dihydropyridin-Kalziumkanalblocker erhalten.

  • Auch Altershypertoniker profitieren von einer antihypertensiven Therapie. Bei Patienten mit isolierter systolischer Hypertonie können z. B. durch Therapie mit Chlortalidon und Atenolol das Auftreten von Herzinfarkt, Schlaganfall und Herzinsuffizienz deutlich gesenkt werden.

  • Schwangere sollten mit Methyldopa oder kardioselektiven Beta-Rezeptorenblockern — wie z. B. Metoprolol oder Atenolol — behandelt werden. ACE-Hemmer oder AT1- Blocker führen eventuell zu einem Oligohydrammion und einer Nierenfunktionsverschlechterung beim Neugeborenen. Somit ist ihr Einsatz nicht angezeigt. Es existieren vielfältige Empfehlungen zur antihypertensiven Therapie. In den deutschsprachigen Ländern findet in dieser Hinsicht das Schema der Deutschen Liga zur Bekämpfung des hohen Blutdrucks besondere Beachtung (Abb. 14.1; [1]).

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Authors
  1. W. Kirch
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Editors and Affiliations

  1. Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, D-30623, Hannover, Deutschland

    J. C. Frölich

  2. Medizinische Fakultät, Institut für klinische Pharmakologie, Technische Universität Dresden, Fiedlerstr. 27, D-01307, Dresden, Deutschland

    W. Kirch

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Kirch, W. (2003). Therapie kardiovaskulärer Erkrankungen. In: Frölich, J.C., Kirch, W. (eds) Praktische Arzneitherapie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-09397-9_14

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  • DOI: https://doi.org/10.1007/978-3-662-09397-9_14

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-01025-8

  • Online ISBN: 978-3-662-09397-9

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