Fehldiagnosen
Bluthochdruck und
Herz-Kreislauferkrankungen
Die Diagnose
Bluthochdruck ist häufig eine Fehldiagnose und
zieht bei vielen zehntausend Patienten überflüssige,
nebenwirkungsbelastete und teure
Arzneimitteltherapien nach sich.
Jüngste Forschungsergebnisse zeigten, dass die mit schweren
Nebenwirkungen behaftete medikamentöse Therapie bei leichtem bis
mittelgradigem Bluthochdruck das
Herz-Kreislauf-Risiko nicht positiv beeinflusst
und daher überflüssig ist (siehe
hier).
Hinzu
kommt, dass die Diagnose Bluthochdruck häufig ausschließlich
aufgrund von wenigen Messungen gestellt wird, die ausschließlich in
der Arztpraxis durchgeführt wurden. Doch dort wird insbesondere bei
sensiblen Menschen lediglich ein sog. "Weißkittel-Bluthochdruck" festgestellt - ein
Blutdruck also, der aufgrund von psychischem Stress kurzfristig
erhöht war und keinerlei negative Folgen hat.
Dieser kurzfristig
erhöhte Blutdruck kann dann bei Messungen im normalen
Umfeld des jeweiligen Patienten - meist durch diesen selbst
durchgeführt - nicht bestätigt werden.
Bereits im Jahr 2011
konnten spanische Wissenschaftler zeigen, dass diese
verhängnisvollen
Fehldiagnosen alles andere als selten sind. Eine
Arbeitsgruppe um Professor de
la
Sierra,
Department
of Internal Medicine, Hospital Mutua Terrassa, University of
Barcelona, wies nach, dass unter mehr als 68.000
Hochdruckpatienten 8.295 unter einer
therapieresistenten Hypertonie litten. Von diesen hatten wiederum
37,5% lediglich eine "Weißkittel-Hypertonie" hatten und somit keine
blutdrucksenkende Behandlung benötigten. Die Therapieresistenz wurde
dokumentiert, wenn der in der Arztpraxis gemessene Blutdruck - trotz
der Gabe von mindestens drei blutdrucksenkenden Medikamenten - nicht
unter über 140/90 mm Hg abgesenkt werden konnte.
Wie hoch
der Anteil der
Weißkittel-Pseudo-Hypertonien bei den rund
60.000 Hypertonikern war, die auf die verabreichten Medikamente mit
der gewünschten
Blutdrucksenkung reagierten, blieb in der Studie
ungeklärt.
Ambulatory monitoring reveals many patients have 'white coat'
hypertension March 28, 2011 A third of patients thought to have
resistant hypertension had "white coat" hypertension during
24-hour ambulatory monitoring, in a large study reported in
Hypertension: Journal of the American Heart Association. Ads by
Google Brain Training Games - Improve memory and attention with
scientific brain games. - www.lumosity.com In ambulatory blood
pressure monitoring, the patient's blood pressure is checked at
regular intervals under normal living and working conditions.
Resistant hypertension occurs when a patient's blood pressure
remains above treatment goals, despite using three different
types of drugs at the same time. In "white coat" hypertension, a
patient's blood pressure is high at the doctor's office but
normal in everyday life. "Ambulatory monitoring showed that many
of these patients' blood pressures were in the normal range when
they were at home or participating in their usual activities,"
said Alejandro de la Sierra, M.D., lead author of the study and
director of internal medicine at Hospital Mutua Terrassa,
University of Barcelona in Spain. "While those who actually had
'white coat' hypertension are not risk free, their
cardiovascular outcomes are much better." The study included
69,045 patients with hypertension — defined as systolic blood
pressure of 140 millimeters of mercury (mm Hg) or above and
diastolic blood pressure of 90 mm Hg or above — in the Spanish
Ambulatory Blood Pressure registry. Fifty-one percent were men
and their average age was 64 years. Thirty-seven percent of
8,295 patients determined to have resistant hypertension had "white
coat" hypertension after being tested with ambulatory blood
pressure monitoring for 24 hours. Close to 63 percent had true
resistant hypertension. Researchers based blood pressure
estimates on two readings. They took ambulatory blood pressure
every 20 minutes during the day and night and assessed age,
gender, weight, height, body mass index, duration of
hypertension and known cardiovascular risk factors such as
smoking, diabetes, lipid profile, creatinine levels,
electrocardiograms and clinical cardiovascular disease. The
researchers found: More women (42 percent) had "white coat"
hypertension with ambulatory blood pressure monitoring than men
(34 percent). Those with true resistant hypertension appeared
slightly younger, were more likely male, had a longer duration
of hypertension and a worse cardiovascular risk profile. Those
with true resistant hypertension included a higher number of
smokers, diabetics, and patients with left ventricular
hypertrophy and previous cardiovascular disease. "Those with
true resistant hypertension showed high blood pressure at work,
during the day and at night," de la Sierra said. "The true
resistant group also was more likely to have blood pressures
that abnormally rose during the night when they were sleeping."
It made no difference in target blood pressure goals if
antihypertensive medications were given either in the morning or
at night, researchers said. "Ambulatory blood pressure
monitoring should be mandatory in resistant hypertension
patients to define true and 'white coat' hypertension," de la
Sierra said. Limitations of the study included its
cross-sectional nature and the lack of information to determine
whether patients were taking medications correctly. However, the
high number of patients more closely matched the usual clinical
practice treated by primary care physicians and referral centers.
"Physicians should be encouraged to use ambulatory monitoring to
confirm resistant hypertension in their patients as it would
ensure the most effect treatment options are used," de la Sierra
said. "Patients benefit by knowing whether their blood pressure
is normal during daily activities or still needs the
reinforcement of dietary and drug measures to achieve the goal."
Provided by American Heart Association search and more info
website
Read more at:
http://phys.org/news/2011-03-ambulatory-reveals-patients-white-coat.html#jCp
Ambulatory monitoring reveals many patients have 'white coat'
hypertension March 28, 2011 A third of patients thought to have
resistant hypertension had "white coat" hypertension during
24-hour ambulatory monitoring, in a large study reported in
Hypertension: Journal of the American Heart Association. Ads by
Google Brain Training Games - Improve memory and attention with
scientific brain games. - www.lumosity.com In ambulatory blood
pressure monitoring, the patient's blood pressure is checked at
regular intervals under normal living and working conditions.
Resistant hypertension occurs when a patient's blood pressure
remains above treatment goals, despite using three different
types of drugs at the same time. In "white coat" hypertension, a
patient's blood pressure is high at the doctor's office but
normal in everyday life. "Ambulatory monitoring showed that many
of these patients' blood pressures were in the normal range when
they were at home or participating in their usual activities,"
said Alejandro de la Sierra, M.D., lead author of the study and
director of internal medicine at Hospital Mutua Terrassa,
University of Barcelona in Spain. "While those who actually had
'white coat' hypertension are not risk free, their
cardiovascular outcomes are much better." The study included
69,045 patients with hypertension — defined as systolic blood
pressure of 140 millimeters of mercury (mm Hg) or above and
diastolic blood pressure of 90 mm Hg or above — in the Spanish
Ambulatory Blood Pressure registry. Fifty-one percent were men
and their average age was 64 years. Thirty-seven percent of
8,295 patients determined to have resistant hypertension had "white
coat" hypertension after being tested with ambulatory blood
pressure monitoring for 24 hours. Close to 63 percent had true
resistant hypertension. Researchers based blood pressure
estimates on two readings. They took ambulatory blood pressure
every 20 minutes during the day and night and assessed age,
gender, weight, height, body mass index, duration of
hypertension and known cardiovascular risk factors such as
smoking, diabetes, lipid profile, creatinine levels,
electrocardiograms and clinical cardiovascular disease. The
researchers found: More women (42 percent) had "white coat"
hypertension with ambulatory blood pressure monitoring than men
(34 percent). Those with true resistant hypertension appeared
slightly younger, were more likely male, had a longer duration
of hypertension and a worse cardiovascular risk profile. Those
with true resistant hypertension included a higher number of
smokers, diabetics, and patients with left ventricular
hypertrophy and previous cardiovascular disease. "Those with
true resistant hypertension showed high blood pressure at work,
during the day and at night," de la Sierra said. "The true
resistant group also was more likely to have blood pressures
that abnormally rose during the night when they were sleeping."
It made no difference in target blood pressure goals if
antihypertensive medications were given either in the morning or
at night, researchers said. "Ambulatory blood pressure
monitoring should be mandatory in resistant hypertension
patients to define true and 'white coat' hypertension," de la
Sierra said. Limitations of the study included its
cross-sectional nature and the lack of information to determine
whether patients were taking medications correctly. However, the
high number of patients more closely matched the usual clinical
practice treated by primary care physicians and referral centers.
"Physicians should be encouraged to use ambulatory monitoring to
confirm resistant hypertension in their patients as it would
ensure the most effect treatment options are used," de la Sierra
said. "Patients benefit by knowing whether their blood pressure
is normal during daily activities or still needs the
reinforcement of dietary and drug measures to achieve the goal."
Provided by American Heart Association search and more info
website
Read more at:
http://phys.org/news/2011-03-ambulatory-reveals-patients-white-coat.html#jCp
Ambulatory monitoring reveals many patients have 'white coat'
hypertension March 28, 2011 A third of patients thought to have
resistant hypertension had "white coat" hypertension during
24-hour ambulatory monitoring, in a large study reported in
Hypertension: Journal of the American Heart Association. Ads by
Google Brain Training Games - Improve memory and attention with
scientific brain games. - www.lumosity.com In ambulatory blood
pressure monitoring, the patient's blood pressure is checked at
regular intervals under normal living and working conditions.
Resistant hypertension occurs when a patient's blood pressure
remains above treatment goals, despite using three different
types of drugs at the same time. In "white coat" hypertension, a
patient's blood pressure is high at the doctor's office but
normal in everyday life. "Ambulatory monitoring showed that many
of these patients' blood pressures were in the normal range when
they were at home or participating in their usual activities,"
said Alejandro de la Sierra, M.D., lead author of the study and
director of internal medicine at Hospital Mutua Terrassa,
University of Barcelona in Spain. "While those who actually had
'white coat' hypertension are not risk free, their
cardiovascular outcomes are much better." The study included
69,045 patients with hypertension — defined as systolic blood
pressure of 140 millimeters of mercury (mm Hg) or above and
diastolic blood pressure of 90 mm Hg or above — in the Spanish
Ambulatory Blood Pressure registry. Fifty-one percent were men
and their average age was 64 years. Thirty-seven percent of
8,295 patients determined to have resistant hypertension had "white
coat" hypertension after being tested with ambulatory blood
pressure monitoring for 24 hours. Close to 63 percent had true
resistant hypertension. Researchers based blood pressure
estimates on two readings. They took ambulatory blood pressure
every 20 minutes during the day and night and assessed age,
gender, weight, height, body mass index, duration of
hypertension and known cardiovascular risk factors such as
smoking, diabetes, lipid profile, creatinine levels,
electrocardiograms and clinical cardiovascular disease. The
researchers found: More women (42 percent) had "white coat"
hypertension with ambulatory blood pressure monitoring than men
(34 percent). Those with true resistant hypertension appeared
slightly younger, were more likely male, had a longer duration
of hypertension and a worse cardiovascular risk profile. Those
with true resistant hypertension included a higher number of
smokers, diabetics, and patients with left ventricular
hypertrophy and previous cardiovascular disease. "Those with
true resistant hypertension showed high blood pressure at work,
during the day and at night," de la Sierra said. "The true
resistant group also was more likely to have blood pressures
that abnormally rose during the night when they were sleeping."
It made no difference in target blood pressure goals if
antihypertensive medications were given either in the morning or
at night, researchers said. "Ambulatory blood pressure
monitoring should be mandatory in resistant hypertension
patients to define true and 'white coat' hypertension," de la
Sierra said. Limitations of the study included its
cross-sectional nature and the lack of information to determine
whether patients were taking medications correctly. However, the
high number of patients more closely matched the usual clinical
practice treated by primary care physicians and referral centers.
"Physicians should be encouraged to use ambulatory monitoring to
confirm resistant hypertension in their patients as it would
ensure the most effect treatment options are used," de la Sierra
said. "Patients benefit by knowing whether their blood pressure
is normal during daily activities or still needs the
reinforcement of dietary and drug measures to achieve the goal."
Provided by American Heart Association search and more info
website
Read more at:
http://phys.org/news/2011-03-ambulatory-reveals-patients-white-coat.html#jCp
Quelle: Hypertension,
Journal of the American Heart Association 2011
Zur Originalquelle
hier
(kostenloser Volltext in englischer Sprache)
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