[Treatment of hypertension with consideration of metabolism. A challenge for current therapy of essential hypertension].
In the modern therapeutic approach to hypertension, the aspect of "metabolic side effects" is receiving ever more attention. This is the result of the recognition that high blood pressure forms part of a metabolic syndrome known as syndrome X, the components of which are variously influenced by different antihypertensive agents. Of particular importance seems to be the response of an underlying insulin resistance, since resulting hyperinsulinemia has been shown to be a separate risk factor. Negative metabolic influences on this syndrome may be a reason for inadequate prevention of coronary heart disease, as has been observed under conventional treatment despite effective lowering of blood pressure over many years. The spectrum of relevant antihypertensive drugs contains only few "metabolically neutral" or "metabolically positive" classes of substances, so that particular importance must be attached to ACE-inhibitors for use in patients with a "metabolic risk"; the most thoroughly studied of such inhibitors is captopril. In order to increase the responder rate to about 90%, a combination with low-dose hydrochlorothiazide can be recommended; the negative effect of the thiazide on insulin sensitivity is balanced by the positive effects of captopril. The great practicability of the single dose form of administration, the synergism of the individual substances, and "metabolic neutrality", together with the high level of tolerability underscore the advantage of this combination treatment.
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D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003327:Coronary Disease / Q000097:blood / Q000517:prevention & control; D004734:Energy Metabolism / Q000187:drug effects*; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000139:chemically induced*; D006949:Hyperlipidemias / Q000097:blood / Q000139:chemically induced*; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D007333:Insulin Resistance; D012307:Risk Factors; D013577:Syndrome
D000959:Antihypertensive Agents
Hypertoniebehandlung mit Rücksicht auf den Stoffwechsel. Eine Forderung an die heutige Therapie der essentiellen Hypertonie.