nach oben

Die Innere Medizin

Erschienen in:

01.05.2005 | Schwerpunkt: Hypertonie

Blutdruck und Gehirn

verfasst von: Prof. Dr. A. Hartmann, S. Moskau

Erschienen in: Die Innere Medizin | Ausgabe 5/2005

Einloggen, um Zugang zu erhalten

Zusammenfassung

Bei akutem zerebralem Insult ist die Autoregulation aufgehoben, die Hirndurchblutung hängt direkt vom Perfusionsdruck ab. Im frühen Infarktstadium wird daher der Blutdruck erst ab Werten >210 mmHg systolisch gesenkt. Mit Ausbildung eines vasogenen Hirnödems bzw. nach Zerstörung der Blut-Hirn-Schranke (ab dem 2.–4. Tag nach Insult) muss der Blutdruck zur Vermeidung von Blutungskomplikationen und zur Eindämmung des Ödems auf Normalwerte gesenkt werden. Patienten mit intrakranieller Blutung profitieren nicht von einem erhöhten Blutdruck. Bei Vorliegen eines raumfordernden Ödems und intrakraniellen Blutungen dürfen nur Substanzen verwendet werden, die keine Gefäßerweiterung der Hirngefäße verursachen: Direkte Vasodilatatoren und Kalziumantagonisten sind für dieses Stadium nicht geeignet. Da die Hirndurchblutung auch vom Herz-Minuten-Volumen abhängt, sollten auch Antihypertonika, die eine Bradykardie verursachen können (β-Blocker), vermieden werden.

Die Effektivität der medikamentösen Primär- bzw. Sekundärprophylaxe von Schlaganfällen ist weitgehend unabhängig von der Art des Antihypertonikums. Wichtig ist eine möglichst tiefe Normalisierung des Blutdrucks. Mittels effektiver Blutdrucknormalisierung gelingt wahrscheinlich auch die Prophylaxe der vaskulär bedingten Demenz. Ausreichend überzeugende Studien fehlen jedoch für fast alle Antihypertonika.

American Heart Association (2003) Heart Disease and Stroke Statistics — Update

Kjeldsen SE, Julius S, Hedner T, Hansson L (2001) Stroke is more common than myocardial infarction in hypertension: analysis based on 11 major randomized intervention trials. Blood Press 10: 190–192

Rodgers A, MacMahon S, Gamble G, Slattery J, Sandercock P, Warlow C (1996) Blood pressure and risk of stroke in patients with cerebrovascular disease. The United Kingdom Transient Ischaemic Attack Collaborative Group. BMJ 313: 147

Prospective studies collaboration (1995) Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 346: 1647–1653

Eastern Stroke and Coronary Heart Disease Collaborative Research Group (1998) Blood pressure, cholesterol, and stroke in eastern Asia. Lancet 352: 1801–1807

MacMahon S, Peto R, Cutler J et al. (1990) Blood pressure, stroke, and coronary heart disease. Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335: 765–774

WHO (2002) The World Health report 2002: reducing risks, promoting healthy life.

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360: 1903–1913

Lawes CM, Rodgers A, Bennett DA, Parag V, Suh I, Ueshima H, MacMahon S (2003) Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens 21: 707–716

10.

MacMahon S, Rodgers A (1994) Blood pressure, antihypertensive treatment and stroke risk. J Hypertens 12 [Suppl]: S5–14

11.

Klungel OH, Kaplan RC, Heckbert SR et al. (2000) Control of blood pressure and risk of stroke among pharmacologically treated hypertensive patients. Stroke 31: 420–424

12.

SHEP Cooperative Research Group (1991) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265: 3255–3264

13.

Kaplan RC (2001) Treatment of hypertension to prevent stroke: translating evidence into clinical practice. J Clin Hypertens 3: 153–156

14.

Prisant LM, Moser M (2000) Hypertension in the elderly: can we improve results of therapy? Arch Intern Med 160: 283–289

15.

Kernan WN, Viscoli CM, Brass LM, Makuch RW, Sarrel PM, Horwitz RI (2000) Blood pressure exceeding national guidelines among women after stroke. Stroke 31: 415–419

16.

Perry HM, Davis BR, Price TR et al. (2000) Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA 284: 465–471

17.

Hansson L, Zanchetti A, Carruthers SG et al. (1998) Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 351: 1755–1762

18.

Estacio RO, Jeffers BW, Hiatt WR, Biggerstaff SL, Gifford N, Schrier RW (1998) The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension. N Engl J Med 338: 645–652

19.

UK Prospective Diabetes Study Group (1998) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317: 703–713

20.

Collins R, MacMahon S (1994) Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease. Br Med Bull 50: 272–298

21.

Neal B, MacMahon S, Chapman N (2000) Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists‘ Collaboration. Lancet 356: 1955–1964

22.

Rashid P, Leonardi-Bee J, Bath P (2003) Blood pressure reduction and secondary prevention of stroke and other vascular events: a systematic review. Stroke 34: 2741–2748

23.

Rossi G, Rossi A, Sacchetto A, Pavan E, Pessina AC (1995) Hypertensive cerebrovascular disease and the renin-angiotensin system. Stroke 26: 1700–1706

24.

Farmer JA, Torre-Amione G (2001) The renin angiotensin system as a risk factor for coronary artery disease. Curr Atheroscler Rep 3: 117–124

25.

Willich SN, Levy D, Rocco MB, Tofler GH, Stone PH, Muller JE (1987) Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol 60: 801–806

26.

Muller JE, Ludmer PL, Willich SN, Tofler GH, Aylmer G, Klangos I, Stone PH (1987) Circadian variation in the frequency of sudden cardiac death. Circulation 75: 131–138

27.

White WB (2001) Cardiovascular risk and therapeutic intervention for the early morning surge in blood pressure and heart rate. Blood Press Monit 6: 63–72

28.

Kario K, Pickering TG, Matsuo T, Hoshide S, Schwartz JE, Shimada K (2001) Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension 38: 852–857

29.

Kario K, Pickering TG, Umeda Y et al. (2003) Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 107: 1401–1406

30.

Shimada K, Kario K (1997) Altered circadian rhythm of blood pressure and cerebrovascular damage. Blood Press Monit 2: 333–338

31.

Panza JA, Epstein SE, Quyyumi AA (1991) Circadian variation in vascular tone and its relation to alpha-sympathetic vasoconstrictor activity. N Engl J Med 325: 986–990

32.

Muller JE, Abela GS, Nesto RW, Tofler GH (1994) Triggers, acute risk factors and vulnerable plaques: the lexicon of a new frontier. J Am Coll Cardiol 23: 809–813

37.

Wallace JD, Levy LL (1981) Blood pressure after stroke. JAMA 246: 2177–2180

38.

Leonardi-Bee J, Bath PM, Phillips SJ, Sandercock PA (2002) Blood pressure and clinical outcomes in the International Stroke Trial. Stroke 33: 1315–1320

39.

Carlberg B, Asplund K, Hagg E (1991) Factors influencing admission blood pressure levels in patients with acute stroke. Stroke 22: 527–530

40.

Loyke HF (1983) Lowering of blood pressure after stroke. Am J Med Sci 286: 2–11

41.

Morfis L, Schwartz RS, Poulos R, Howes LG (1997) Blood pressure changes in acute cerebral infarction and hemorrhage. Stroke 28: 1401–1405

42.

Britton M, Carlsson A (1990) Very high blood pressure in acute stroke. J Intern Med 228: 611–615

43.

Davalos A, Toni D, Iweins F, Lesaffre E, Bastianello S, Castillo J (1999) Neurological deterioration in acute ischemic stroke: potential predictors and associated factors in the European Cooperative Acute Stroke Study (ECASS) I. Stroke 30: 2631–2636

44.

Brott T, Reed RL (1989) Intensive care for acute stroke in the community hospital setting. The first 24 hours. Stroke 20: 694–697

45.

Spence JD, Del Maestro RF (1985) Hypertension in acute ischemic strokes. Treat Arch Neurol 42: 1000–1002

46.

Britton M, Roden A (1985) Progression of stroke after arrival at hospital. Stroke 16: 629–632

47.

Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS (1994) Effect of blood pressure and diabetes on stroke in progression. Lancet 344: 156–159

48.

Britton M, Carlsson A, de Faire U (1986) Blood pressure course in patients with acute stroke and matched controls. Stroke 17: 861–864

49.

Lavin P (1986) Management of hypertension in patients with acute stroke. Arch Intern Med 146: 66–68

50.

Yatsu FM, Zivin J (1985) Hypertension in acute ischemic strokes. Not to treat. Arch Neurol 42: 999–1000

51.

Ahmed N, Wahlgren G (2001) High initial blood pressure after acute stroke is associated with poor functional outcome. J Intern Med 249: 467–473

52.

M’Buyamba-Kabangu JR, Longo-Mbenza B, Tambwe MJ, Dikassa LN, Mbala-Mukendi M (1995) J-shaped relationship between mortality and admission blood pressure in black patients with acute stroke. J Hypertens 13: 1863–1868

53.

Lisk DR, Grotta JC, Lamki LM, Tran HD, Taylor JW, Molony DA, Barron BJ (1993) Should hypertension be treated after acute stroke? A randomized controlled trial using single photon emission computed tomography. Arch Neurol 50: 855–862

54.

Dyker AG, Grosset DG, Lees K (1997) Perindopril reduces blood pressure but not cerebral blood flow in patients with recent cerebral ischemic stroke. Stroke 28: 580–583

55.

Butterworth RJ, Cluckie A, Jackson SH, Buxton-Thomas M, Bath PM (1998) Pathophysiological assessment of nitric oxide (given as sodium nitroprusside) in acute ischaemic stroke. Cerebrovasc Dis 8: 158–165

56.

Schwarz S, Georgiadis D, Aschoff A, Schwab S (2002) Effects of induced hypertension on intracranial pressure and flow velocities of the middle cerebral arteries in patients with large hemispheric stroke. Stroke 33: 998–1004

57.

Wise G, Sutter R, Burkholder J (1972) The treatment of brain ischemia with vasopressor drugs. Stroke 3: 135–140

58.

Rordorf G, Cramer SC, Efird JT, Schwamm LH, Buonanno F, Koroshetz WJ (1997) Pharmacological elevation of blood pressure in acute stroke. Clinical effects and safety. Stroke 28: 2133–2138

59.

Treib J, Haass A, Krammer I, Stoll M, Grauer MT, Schimrigk K (1996) Cardiac output in patients with acute stroke. J Neurol 243: 575–578

60.

Saxena R, Wijnhoud AD, Carton H et al. (1999) Controlled safety study of a hemoglobin-based oxygen carrier, DCLHb, in acute ischemic stroke. Stroke 30: 993–996

61.

(1973) Control of moderately raised blood pressure. Report of a co-operative randomized controlled trial. BMJ 3: 434–436

62.

Carter AB (1970) Hypotensive therapy in stroke survivors. Lancet 1: 485–489

63.

Coope J, Warrender TS (1986) Randomised trial of treatment of hypertension in elderly patients in primary care. Br Med J (Clin Res Ed) 293: 1145–1151

64.

The Dutch TIA Trial Study Group (1993) Trial of secondary prevention with atenolol after transient ischemic attack or nondisabling ischemic stroke. Stroke 24: 543–548

65.

Amery A, Birkenhager W, Brixko P et al. (1985) Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet 1: 1349–1354

66.

Hypertension Detection and Follow-up Program Cooperative Group (1979) Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 242: 2562–2571

67.

MRC Working Party (1992) Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 304: 405–412

68.

Medical Research Council Working Party (1985) MRC trial of treatment of mild hypertension: principal results. Br Med J (Clin Res Ed) 291: 97–104

69.

Helgeland A (1980) Treatment of mild hypertension: a five year controlled drug trial. The Oslo study. Am J Med 69: 725–732

70.

Dahlof B, Lindholm LH, Hansson L, Schersten B, Ekbom T, Wester PO (1991) Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 338: 1281–1285

71.

Smith WM (1977) Treatment of mild hypertension: results of a ten-year intervention trial. Circ Res 40 [Suppl 1]: 198–105

72.

(1967) Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 m Hg. JAMA 202: 1028–1034

73.

Perry HM (1977) Treatment of mild hypertension. Preliminary results of a two-year feasibility trial. Circ Res 40 [Suppl 1]: I180–I187

74.

Wolff FW, Lindeman RD (1966) Effects of treatment in hypertension. Results of a controlled study. J Chronic Dis 19: 227–240

75.

Pitt B, Byington RP, Furberg CD, Hunninghake DB, Mancini GB, Miller ME, Riley W (2000) Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. PREVENT Investigators. Circulation 102: 1503–1510

76.

Staessen JA, Fagard R, Thijs L et al. (1997) Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 350: 757–764

77.

Brown MJ, Palmer CR, Castaigne A, de Leeuw PW, Mancia G, Rosenthal T, Ruilope LM (2000) Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 356: 366–372

78.

Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342: 145–153

79.

MacMahon S, Sharpe N, Gamble G et al. (2000) Randomized, placebo-controlled trial of the angiotensin-converting enzyme inhibitor, ramipril, in patients with coronary or other occlusive arterial disease. PART-2 Collaborative Research Group. Prevention of Atherosclerosis with Ramipril. J Am Coll Cardiol 36: 438–443

80.

PROGRESS Collaborative Group (2001) Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 358: 1033–1041

81.

Cashin-Hemphill L, Holmvang G, Chan RC, Pitt B, Dinsmore RE, Lees RS (1999) Angiotensin-converting enzyme inhibition as antiatherosclerotic therapy: no answer yet. QUIET Investigators. QUinapril Ischemic Event Trial. Am J Cardiol 83: 43–47

82.

Teo KK, Burton JR, Buller CE, Plante S et al. (2000) Long-term effects of cholesterol lowering and angiotensin-converting enzyme inhibition on coronary atherosclerosis: The Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT). Circulation 102: 1748–1754

83.

Heart Outcomes Prevention Evaluation Study Investigators (2000) Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 355: 253–259

84.

Davies MJ (1998) Reactive oxygen species, metalloproteinases, and plaque stability. Circulation 97: 2382–2383

85.

Schrader J, Luders S, Kulschewski A et al. (2003) The ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke 34: 1699–1703

86.

Gueyffier F, Boissel JP, Boutitie F et al. (1997) Effect of antihypertensive treatment in patients having already suffered from stroke. Gathering the evidence. The INDANA (INdividual Data ANalysis of Antihypertensive intervention trials) Project Collaborators. Stroke 28: 2557–2562

87.

ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (2002) Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 288: 2981–2997

88.

Wing LM, Reid CM, Ryan P et al. (2003) A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 348: 583–592

89.

Hansson L, Lindholm LH, Niskanen L et al. (1999) Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 353: 611–616

90.

Hansson L, Lindholm LH, Ekbom T et al. (1999) Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 354: 1751–1756

91.

UK Prospective Diabetes Study Group (1998) Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 317: 713–720

92.

Casiglia E, Spolaore P, Mazza A et al. (1994) Effect of two different therapeutic approaches on total and cardiovascular mortality in a Cardiovascular Study in the Elderly (CASTEL). Jpn Heart J 35: 589–600

93.

Black HR, Elliott WJ, Grandits G et al. (2003) Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. JAMA 289: 2073–2082

94.

Zanchetti A, Bond MG, Hennig M et al. (2002) Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis: principal results of the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind, long-term trial. Circulation 106: 2422–2427

95.

Borhani NO, Mercuri M, Borhani PA et al. (1996) Final outcome results of the Multicenter Isradipine Diuretic Atherosclerosis Study (MIDAS). A randomized controlled trial. JAMA 276: 785–791

96.

National Intervention Cooperative Study in Elderly Hypertensives Study Group (1999) Randomized double-blind comparison of a calcium antagonist and a diuretic in elderly hypertensives. Hypertension 34: 1129–1133

97.

Hansson L, Hedner T, Lund-Johansen P et al. (2000) Randomised trial of effects of calcium antagonists compared with diuretics and beta-blockers on cardiovascular morbidity and mortality in hypertension: the Nordic Diltiazem (NORDIL) study. Lancet 356: 359–365

98.

Zanchetti A, Rosei EA, Dal Palu C, Leonetti G, Magnani B, Pessina A (1998) The Verapamil in Hypertension and Atherosclerosis Study (VHAS): results of long-term randomized treatment with either verapamil or chlorthalidone on carotid intima-media thickness. J Hypertens 16: 1667–1676

99.

Rosei EA, Dal Palu C, Leonetti G, Magnani B, Pessina A, Zanchetti A (1997) Clinical results of the Verapamil in Hypertension and Atherosclerosis Study. VHAS Investigators. J Hypertens 15: 1337–1344

100.

Tatti P, Pahor M, Byington RP, Di Mauro P, Guarisco R, Strollo G, Strollo F (1998) Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and NIDDM. Diabetes Care 21: 597–603

101.

Staessen JA, Wang JG, Thijs L (2001) Cardiovascular protection and blood pressure reduction: a meta-analysis. Lancet 358: 1305–1315

102.

Bosch J, Yusuf S, Pogue J et al. (2002) Use of ramipril in preventing stroke: double blind randomised trial. BMJ 324: 699–702

103.

Dahlof B, Devereux RB, Kjeldsen SE et al. (2002) Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359: 995–1003

104.

Kjeldsen SE, Dahlof B, Devereux RB et al. (2002) Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: a Losartan Intervention for Endpoint Reduction (LIFE) substudy. JAMA 288: 1491–1498

105.

Julius S, Kjeldsen SE, Weber M et al. (2004) Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 363: 2022–2031

106.

Lithell H, Hansson L, Skoog I, Elmfeldt D, Hofman A, Olofsson B, Trenkwalder P, Zanchetti A (2003) The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens 21: 875–886

107.

Teo K, Yusuf S, Sleight P et al. (2004) Rationale, design, and baseline characteristics of 2 large, simple, randomized trials evaluating telmisartan, ramipril, and their combination in high-risk patients: the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) trials. Am Heart J 148: 52–61

108.

Gueyffier F, Boutitie F, Boissel JP et al. (1995) INDANA: a meta-analysis on individual patient data in hypertension. Protocol and preliminary results. Therapie 50: 353–362

109.

Gueyffier F, Froment A, Gouton M (1996) New meta-analysis of treatment trials of hypertension: improving the estimate of therapeutic benefit. J Hum Hypertens 10: 1–8

110.

Gueyffier F, Bulpitt C, Boissel JP et al. (1999) Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet 353: 793–796

111.

MacMahon S, Rodgers A (1993) The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives. Clin Exp Hypertens 15: 967–978

112.

Insua JT, Sacks HS, Lau TS, Lau J, Reitman D, Pagano D, Chalmers TC (1994) Drug treatment of hypertension in the elderly: a meta-analysis. Ann Intern Med 121: 355–362

113.

Truelsen T, Bonita R, Jamrozik K (2001) Surveillance of stroke: a global perspective. Int J Epidemiol 30 [Suppl 1]: S11–S16

114.

Chobanian AV, Bakris GL, Black HR et al. (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289: 2560–2572

115.

Sacks FM, Svetkey LP, Vollmer WM et al. (2001) Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 344: 3–10

116.

Mellion MB (1994) Exercise: how much is enough, and how much is too much? Heart Dis Stroke 3: 2–4

117.

Cruickshank JM (1994) J curve in antihypertensive therapy--does it exist? A personal point of view. Cardiovasc Drugs Ther 8: 757–760

118.

Farnett L, Mulrow CD, Linn WD, Lucey CR, Tuley MR (1991) The J-curve phenomenon and the treatment of hypertension. Is there a point beyond which pressure reduction is dangerous? JAMA 265: 489–495

119.

Sleight P (1997) Lowering of blood pressure and artery stiffness. Lancet 349: 362

120.

Cruickshank J (2001) The lowering of blood pressure after stroke. Lancet 358: 1994–1995

121.

McMurray J, McInnes GT (1992) The J-curve hypothesis. Lancet 339: 561–562

122.

Jansen PA, Schulte BP, Gribnau FW (1987) Cerebral ischaemia and stroke as side effects of antihypertensive treatment; special danger in the elderly. A review of the cases reported in the literature. Neth J Med 30: 193–201

123.

Rothwell PM, Howard SC, Spence JD (2003) Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease. Stroke 34: 2583–2590

124.

Klaus D (1983) Akute hypertensive Enzephalopathie, Diagnostik und Therapie. Intensivmedizin

125.

Hirschl MM, Seidler D, Zeiner A, Wagner A, Heinz G, Sterz F, Laggner AN (1993) Intravenous urapidil versus sublingual nifedipine in the treatment of hypertensive urgencies. Am J Emerg Med 11: 653–656

126.

Varriale P, David W, Chryssos BE (1993) Hemodynamic response to intravenous enalaprilat in patients with severe congestive heart failure and mitral regurgitation. Clin Cardiol 16: 235–238

127.

Sparks DL, Scheff SW, Liu H, Landers TM, Coyne CM, Hunsaker JC (1995) Increased incidence of neurofibrillary tangles (NFT) in non-demented individuals with hypertension. J Neurol Sci 131: 162–169

128.

Tatemichi TK, Paik M, Bagiella E et al. (1994) Risk of dementia after stroke in a hospitalized cohort: results of a longitudinal study. Neurology 44: 1885–1891

129.

Starr JM, Whalley LJ, Inch S, Shering PA (1993) Blood pressure and cognitive function in healthy old people. J Am Geriatr Soc 41: 753–756

130.

Kuusisto J, Koivisto K, Mykkanen L et al. (1993) Essential hypertension and cognitive function. The role of hyperinsulinemia. Hypertension 22: 771–779

131.

Battersby C, Hartley K, Fletcher AE et al. (1993) Cognitive function in hypertension: a community based study. J Hum Hypertens 7: 117–123

132.

Elias MF, Wolf PA, D’Agostino RB, Cobb J, White LR (1993) Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol 138: 353–364

133.

Kuusisto J, Koivisto K, Mykkanen L et al. (1997) Association between features of the insulin resistance syndrome and Alzheimer’s disease independently of apolipoprotein E4 phenotype: cross sectional population based study. BMJ 315: 1045–1049

134.

Kilander L, Nyman H, Boberg M, Hansson L, Lithell H (1998) Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men. Hypertension 31: 780–786

135.

Farmer ME, Kittner SJ, Abbott RD, Wolz MM, Wolf PA, White LR (1990) Longitudinally measured blood pressure, antihypertensive medication use, and cognitive performance: the Framingham Study. J Clin Epidemiol 43: 475–480

136.

in’t Veld BA, Ruitenberg A, Hofman A, Stricker BH, Breteler MM (2001) Antihypertensive drugs and incidence of dementia: the Rotterdam Study. Neurobiol Aging 22: 407–412

137.

Forette F, Seux ML, Staessen JA et al. (1998) Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet 352: 1347–1351

138.

Kario K, Pickering TG (1999) Calcium antagonist and prevention of dementia in elderly people. Lancet 353: 1184

139.

Guo Z, Viitanen M, Fratiglioni L, Winblad B (1996) Low blood pressure and dementia in elderly people: the Kungsholmen project. BMJ 312: 805–808

140.

Bulpitt C, Fletcher A, Beckett N et al. (2001) Hypertension in the Very Elderly Trial (HYVET): protocol for the main trial. Drugs Aging 18: 151–164

141.

Hansson L, Lithell H, Skoog I et al. (2000) Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics. Blood Press 9: 146–151

142.

Prince MJ, Biord AS, Blizard RA et al. (1996) Is the cognitive function of older patients affected by antihypertensive treatment. BMJ 312: 801–805

143.

Heckbert SR, Longstreth WT, Psaty PM et al. (1997) The association of antihypertensive agnets with MRI white matter findings and the modified Mini-Mental-State Examination in older adults. Am Geriatr Soc 45: 1423–1433

144.

Maxwell CJ, Hogan DB, Ebly EM (1999) Calcium channel blockers and cognitive function in elderly people: results from the Canadian study of health and aging. Can Med Assoc J 161: 501–506

Titel: Blutdruck und Gehirn
verfasst von: Prof. Dr. A. Hartmann
S. Moskau
Publikationsdatum: 01.05.2005
Verlag: Springer-Verlag
Erschienen in: Die Innere Medizin / Ausgabe 5/2005
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI: https://doi.org/10.1007/s00108-005-1406-9

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2005

Lebersequenzszintigraphie zur Diagnostik von Rundherden

Arterielle Hypertonie

Blutdruckunabhängige Wirkungen von Antihypertensiva

Pharmakotherapie chronisch entzündlicher Darmerkrankungen

„Ein Mensch, der so von seinem Körper abhängt wie ich!“