Arterielle Hypertonie 2015 - J.Maurus OSK Klinikum Westallgäu Wangen - Oberschwabenklinik
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Arterielle Hypertonie
2015
J.Maurus
OSK Klinikum Westallgäu Wangen
OBERSCHWABENKLINIK
OSK Klinikum Westallgäu
Wangen
OBERSCHWABENKLINIK
Arterielle Hypertonie
Definition
Epidemiologie
Diagnostik
Therapie
OBERSCHWABENKLINIK
OBERSCHWABENKLINIK
Arterielle Hypertonie
Definition
Epidemiologie
Diagnostik
Therapie
OBERSCHWABENKLINIK
systolisch diastolisch
(mmHg) (mmHg)
normaler Blutdruck 120-129 80-84
hochnormaler Blutdruck 130-139 85-89
Grad 1: leichter Bluthochdruck 140-159 90-99
Grad 2: mittelschwerer Bluthochdruck 160-179 100-109
Grad 3: schwerer Bluthochdruck über 180 über 110
isolierter systolischer Bluthochdruck über 140 unter 90
Der Praxisblutdruck ist das Mittel aus 2 Messungen im Abstand von 2 Minuten mit
einem validierten Gerät nach 3-5 Minuten Sitzen an mindestens 2 Terminen.
OBERSCHWABENKLINIK
OBERSCHWABENKLINIK
Arterielle Hypertonie
Definition
Epidemiologie
Diagnostik
Therapie
OBERSCHWABENKLINIK
Bluthochdruck
Zu wenig beachtet,
zu wenig behandelt
▪ In Deutschland leiden nach Schätzungen von
Experten 18*-35** Mio. an Bluthochdruck.
▪ Millionen wissen es nicht, Millionen, die es wissen,
sind unzureichend behandelt.
* Hochrechnung KORA St. (Meisinger et al., Journal of Hypertension; 24: 293-299)
** Quelle: Hochdruckliga 2011
OBERSCHWABENKLINIK
Arterielle Hypertonie
Niedriger oder normaler Blutdruck entwickelt sich
häufig im Lauf des Lebens zu hohem Blutdruck:
Ab 60 Jahren hat jeder Zweite einen
hohen Blutdruck.
Bei sehr Alten sind es 80-90 %.
OBERSCHWABENKLINIKArterielle Hypertonie
Definition
Epidemiologie
Diagnostik
Therapie
OBERSCHWABENKLINIKOBERSCHWABENKLINIK
Titel OBERSCHWABENKLINIK
OBERSCHWABENKLINIK
OBERSCHWABENKLINIK
OBERSCHWABENKLINIK
• Search for sleep disorders
OBERSCHWABENKLINIKMUCH (masked uncontrolled
hypertension)
4608 (31,3%) von 14840 Pat. mit
behandelter und kontrollierter Hypertonie
OBERSCHWABENKLINIKArterielle Hypertonie
Definition
Epidemiologie
Diagnostik
Therapie
OBERSCHWABENKLINIKWie tief soll der Blutdruck
gesenkt werden?
Patienten Blutdruckziele
Patienten 60 Jahre und älter unter 150/90 mmHg
alle Patienten unter 60 Jahre unter 140/90 mmHg
Patienten mit Herzkranzgefäß- unter 140/90 mmHg
erkrankungen, Nierenschaden,
Diabetes mellitus
bei Nierenschaden mit krankhafter unter 140/90 mmHg
Eiweißausscheidung im Urin
2014 Evidence-based Guideline for thr Management of High Blood Pressure in Adults
Paul A.James et al. JAMA.2014;311(5):507-520
OBERSCHWABENKLINIKOriginal Article
Benazepril plus Amlodipine or Hydrochlorothiazide
for Hypertension in High-Risk Patients
Kenneth Jamerson, M.D., Michael A. Weber, M.D., George L. Bakris, M.D., Björn
Dahlöf, M.D., Bertram Pitt, M.D., Victor Shi, M.D., Allen Hester, Ph.D., Jitendra Gupte,
M.S., Marjorie Gatlin, M.D., Eric J. Velazquez, M.D., for the ACCOMPLISH Trial
Investigators
N Engl J Med
Volume 359(23):2417-2428
December 4, 2008
OBERSCHWABENKLINIKStudy Overview
• The optimal combination drug therapy for treatment
of hypertension is not established, although current
U.S. guidelines recommend inclusion of a diuretic
OBERSCHWABENKLINIKatment on Systolic and Diastolic Blood Pressure over Time
Med 2008;359:2417-2428
OBERSCHWABENKLINIKKaplan-Meier Curves for Time to First Primary Composite End Point
2008;359:2417-2428
OBERSCHWABENKLINIKard Ratios for the Primary Outcome and the Individual Components
J Med 2008;359:2417-2428
OBERSCHWABENKLINIKafety Analysis
08;359:2417-2428
OBERSCHWABENKLINIKConclusion
• The benazepril-amlodipine combination was superior
to the benazepril-hydrochlorothiazide combination in
reducing cardiovascular events in patients with
hypertension who were at high risk for such events
OBERSCHWABENKLINIKReview Article
Use of Diuretics in Patients with Hypertension
Michael E. Ernst, Pharm.D., and Marvin Moser, M.D.
N Engl J Med
Volume 361(22):2153-2164
November 26, 2009
OBERSCHWABENKLINIKSites of Diuretic Action in the Nephron
Ernst M, Moser M. N Engl J Med 2009;361:2153-2164
OBERSCHWABENKLINIKSummary
• This review focuses on thiazides, the diuretics most
often indicated for long-term therapy for
hypertension.
• Thiazide diuretics reduce blood pressure when
administered as monotherapy; thiazides also
enhance the efficacy of other antihypertensive agents
and can reduce hypertension-related morbidity and
mortality.
OBERSCHWABENKLINIKPotential Complications of Diuretics and Their Associated Mechanisms
Ernst M, Moser M. N Engl J Med 2009;361:2153-2164
OBERSCHWABENKLINIKOriginal Article
Treatment of Hypertension in Patients 80 Years of
Age or Older
Nigel S. Beckett, M.B., Ch.B., Ruth Peters, Ph.D., Astrid E. Fletcher, Ph.D., Jan A.
Staessen, M.D., Ph.D., Lisheng Liu, M.D., Dan Dumitrascu, M.D., Vassil Stoyanovsky,
M.D., Riitta L. Antikainen, M.D., Ph.D., Yuri Nikitin, M.D., Craig Anderson, M.D., Ph.D.,
Alli Belhani, M.D., Françoise Forette, M.D., Chakravarthi Rajkumar, M.D., Ph.D.,
Lutgarde Thijs, M.Sc., Winston Banya, M.Sc., Christopher J. Bulpitt, M.D., for the
HYVET Study Group
N Engl J Med
Volume 358(18):1887-1898
May 1, 2008
OBERSCHWABENKLINIKStudy Overview
• In this study, patients 80 years of age or older with
sustained systolic hypertension were randomly
assigned to receive either the diuretic indapamide,
with or without the angiotensin-converting-enzyme
inhibitor perindopril, or matching placebos, for a
target blood pressure of 150/80 mm Hg
OBERSCHWABENKLINIKMean Blood Pressure, Measured while Patients Were Seated, in the
Intention-to-Treat Population, According to Study Group
Beckett NS et al. N Engl J Med 2008;358:1887-1898
OBERSCHWABENKLINIKMain Fatal and Nonfatal End Points in the Intention-to-Treat Population
Beckett NS et al. N Engl J Med 2008;358:1887-1898
OBERSCHWABENKLINIKConclusion
• The results provide evidence that antihypertensive
treatment with indapamide (sustained release), with
or without perindopril, in persons 80 years of age or
older is beneficial
OBERSCHWABENKLINIKOriginal Article
Global Sodium Consumption and Death from
Cardiovascular Causes
Dariush Mozaffarian, M.D., Dr.P.H., Saman Fahimi, M.D., Gitanjali M. Singh, Ph.D.,
Renata Micha, R.D., Ph.D., Shahab Khatibzadeh, M.D., M.P.H., Rebecca E.
Engell, B.A., Stephen Lim, Ph.D., Goodarz Danaei, Ph.D., Majid Ezzati, Ph.D., John
Powles, M.B., B.S., for the Global Burden of Diseases Nutrition and Chronic Diseases
Expert Group (NUTRICODE)
N Engl J Med
Volume 371(7):624-634
August 14, 2014
OBERSCHWABENKLINIKStudy Overview
• The authors estimate that in 2010, a total of 1.65
million deaths from cardiovascular causes occurred
as a result of excess sodium consumption.
• They assess correlations between sodium
consumption and blood pressure and between blood
pressure and cardiovascular events.
OBERSCHWABENKLINIKEffects of R
2014;371:624-634
OBERSCHWABENKLINIKAbsolute Cardiovascular Mortality Attributed to Sodium Consumption of
More than 2.0 g per Day in 2010, According to Nation.
Mozaffarian D et al. N Engl J Med 2014;371:624-634
OBERSCHWABENKLINIKConclusions
• In this modeling study, 1.65 million deaths from
cardiovascular causes that occurred in 2010 were
attributed to sodium consumption above a reference
level of 2.0 g per day.
OBERSCHWABENKLINIKOriginal Article
Projected Effect of Dietary Salt Reductions on
Future Cardiovascular Disease
Kirsten Bibbins-Domingo, Ph.D., M.D., Glenn M. Chertow, M.D., M.P.H., Pamela G.
Coxson, Ph.D., Andrew Moran, M.D., James M. Lightwood, Ph.D., Mark J. Pletcher,
M.D., M.P.H., and Lee Goldman, M.D., M.P.H.
N Engl J Med
Volume 362(7):590-599
February 18, 2010
OBERSCHWABENKLINIKStudy Overview
• The salt intake of the U.S. population is rising
• Using the Coronary Heart Disease Policy Model,
these investigators found that a reduction in salt
intake of 3 g per day would result in substantial
reductions in the incidence of coronary heart disease,
stroke, and death
• A more modest reduction of 1 g per day would also
have public health benefits
• The reduction of salt intake is an important goal for
the country
OBERSCHWABENKLINIKEstimated Changes in Systolic Blood Pressure Associated with
Reductions in Dietary Salt
Bibbins-Domingo K et al. N Engl J Med 2010;362:590-599
OBERSCHWABENKLINIKProjected Estimates of the Cost and Effectiveness of Salt Reduction and
Hypertension Treatment Annually and Cumulatively, 2010-2019
Bibbins-Domingo K et al. N Engl J Med 2010;362:590-599
OBERSCHWABENKLINIKConclusion
Modest reductions in dietary salt could substantially
reduce cardiovascular events and medical costs and
should be a public health target
OBERSCHWABENKLINIKOriginal Article
A Controlled Trial of Renal Denervation for
Resistant Hypertension
Deepak L. Bhatt, M.D., M.P.H., David E. Kandzari, M.D., William W. O'Neill, M.D.,
Ralph D'Agostino, Ph.D., John M. Flack, M.D., M.P.H., Barry T. Katzen, M.D., Martin B.
Leon, M.D., Minglei Liu, Ph.D., Laura Mauri, M.D., Manuela Negoita, M.D., Sidney A.
Cohen, M.D., Ph.D., Suzanne Oparil, M.D., Krishna Rocha-Singh, M.D., Raymond R.
Townsend, M.D., George L. Bakris, M.D., for the SYMPLICITY HTN-3 Investigators
N Engl J Med
Volume 370(15):1393-1401
April 10, 2014
OBERSCHWABENKLINIKStudy Overview
• In this large trial, denervation of the kidneys with use
of a radiofrequency ablation catheter in the renal
arteries had no significant effect on blood pressure in
patients with resistant hypertension.
• This contradicts results of smaller trials that did not
include a sham control.
OBERSCHWABENKLINIKSecondary Efficacy End Point.
Bhatt DL et al. N Engl J Med 2014;370:1393-1401
OBERSCHWABENKLINIKSelected Subgroup Analyses.
Bhatt DL et al. N Engl J Med 2014;370:1393-1401
OBERSCHWABENKLINIKSafety End Points.
Bhatt DL et al. N Engl J Med 2014;370:1393-1401
OBERSCHWABENKLINIKConclusions
• This blinded trial did not show a significant reduction
of systolic blood pressure in patients with resistant
hypertension 6 months after renal-artery denervation
as compared with a sham control.
OBERSCHWABENKLINIKArteriovenöses Coupler System 83 Pat. RR>140/85 oder>135/85 (24h-RR) 44 Pat. Coupler Endpunkt: RR nach 6 Monaten Ergebnis: Coupler -26,9 (-3,7) mm Hg syst. und -13,5 (-0,5) mm Hg diast.(24h) P jeweils
Special Article
Cost-Effectiveness of Hypertension Therapy
According to 2014 Guidelines
Andrew E. Moran, M.D., M.P.H., Michelle C. Odden, Ph.D., Anusorn
Thanataveerat, M.P.H., Keane Y. Tzong, M.P.H., Petra W. Rasmussen, M.P.H., David
Guzman, M.S.P.H., Lawrence Williams, M.S., Kirsten Bibbins-Domingo, Ph.D., M.D.,
Pamela G. Coxson, Ph.D., and Lee Goldman, M.D., M.P.H.
N Engl J Med
Volume 372(5):447-455
January 29, 2015
OBERSCHWABENKLINIKStudy Overview
• The authors estimate that implementation of the 2014
treatment guidelines for all U.S. patients with
untreated hypertension would save lives and money.
• The value of treatment would be greatest in patients
with severe hypertension and in those with
cardiovascular disease.
OBERSCHWABENKLINIKProjected Average Annual Incremental Results of Providing Therapy for
Patients with Untreated Hypertension between the Ages of 35 and 74 Years
(2014–2024).
Moran AE et al. N Engl J Med 2015;372:447-455
OBERSCHWABENKLINIKConclusions
• The implementation of the 2014 hypertension
guidelines for U.S. adults between the ages of 35
and 74 years could potentially prevent about 56,000
cardiovascular events and 13,000 deaths annually,
while saving costs.
• Controlling hypertension in all patients with
cardiovascular disease or stage 2 hypertension could
be effective and cost-saving.
OBERSCHWABENKLINIKZusammenfassung und
Empfehlungen
Sorgfältige und umfassende (Primär-)
Diagnostik
Behandlung auch der begleitenden
Risikofaktoren
Allgemeinmaßnahmen sinnvoll
Interventionelle Verfahren derzeit nicht
ausreichend validiert
OBERSCHWABENKLINIKOBERSCHWABENKLINIK
OBERSCHWABENKLINIK
OBERSCHWABENKLINIK
OBERSCHWABENKLINIK
Vielen Dank für Ihre
Aufmerksamkeit
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