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Typ-2-Diabetes (T2D) ist weltweit die häufigste Ursache für die Entstehung einer chronischen Nierenerkrankung (CKD), etwa 40 % der Patienten mit T2D entwickeln eine solche. Inzwischen haben sich die Optionen der Nephroprotektion deutlich erweitert. Neben dem bereits langjährig bekannten nephroprotektiven Effekt der Renin-Angiotensin-System-Inhibitoren gibt es weitere evidenzbasierte Therapiemöglichkeiten, um das Fortschreiten der CKD zu verlangsamen, vielleicht sogar in Einzelfällen zu verhindern. Zusätzlich zur antihypertensiven, blutzucker- und lipidspiegelsenkenden Therapie haben inzwischen die SGLT-2-Inhibitoren (SGLT: Natrium-Glukose-Kotransporter), die GLP-1-Rezeptor-Agonisten (GLP: glukagonähnliches Peptid) und die nichtsteroidalen Mineralokortikoidrezeptorantagonisten ihren festen Platz in nationalen und internationalen Leitlinien zur Therapie der CKD bei T2D. Entscheidend ist eine ganzheitliche, individuelle und frühe Therapie der Betroffenen.

AbstractObjective:This retrospective patient data analysis was initiated to describe current treatment patterns of patients in Germany with arterial hypertension, with a special focus on compliance, persistence, and medication costs of fixed-dose and unfixed combinations of angiotensin receptor blockers (ARBs), amlodipine (AML) and hydrochlorothiazide (HCT) in Germany.Methods:The study analyzed prescription data collected by general practitioners, using the IMS Disease Analyzer database. The database was searched for patients with the diagnosis hypertension (ICD-10 code I10) and treatment data in the period 09/2009 to 08/2010. Compliance was measured indirectly based on the medication possession ratio (MPR), and persistence was defined as the duration of time from initiation to discontinuation of therapy. Medication costs were assessed from the statutory health insurance perspective in Germany.Results:In the IMS DA 406,888 observable patients in Germany were encoded with the diagnosis I10 essential hypertension. In total, 88,716 patients received prescriptions including ARBs, monotherapy (18.6%) or unfixed combinations with other anti-hypertensives (19.3%). The compliance with fixed-dose combinations of ARB with HCT, either dual or with one other anti-hypertensive drug, was significantly better, compared to unfixed combinations (mean compliance 78.1% for fixed-dose vs 71.5% for unfixed combinations of ARB with HCT, p < 0.0001; mean compliance 79.4% vs 72.0%, p < 0.0001 if an additional anti-hypertensive medication was added). Fixed-dose combinations of ARB with HCT, ARB with AML, dual only or prescribed with another anti-hypertensive medication resulted in a substantial increase of persistence, especially for patients on fixed-dose dual combinations (225.7 vs 163.6 days for ARB with HCT; 232.9 vs 178.4 days for ARB with AML, respectively). Fixed-dose combinations (varying from €1.38 to €2.20 per patient and day) were on average cheaper than unfixed combinations.Limitations:Persistence and compliance could be under- or over-estimated because their assessment was based on prescription information. For two thirds of 69,060 patients, data on compliance and persistence was missing.Conclusion:The study shows considerable variations in ARB treatment patterns among patients, with the majority of patients treated with fixed-dose or semi-fixed combination therapy. Fixed-dose combinations of ARBs with HCT and/or AML seem to result in better compliance and persistence compared to unfixed regimes of these drug classes, leading to reduction in all-cause hospitalizations, emphasizing the benefit and potential cost-savings of using fixed-dose regimes in a real-life general practice setting in Germany.

Parameters of splanchnic regional perfusion, like intramucosal pH (pHi) and pCO(2) (pCO(2)i), may predict outcome in septic shock patients. Continuous venovenous haemofiltration (CVVH) has been considered beneficial in haemodynamically unstable septic shock patients. In a prospective, randomized, clinical study, we investigated whether CVVH, in comparison to intermittent haemodialysis (IHD), is able to improve splanchnic regional perfusion in critically ill patients.

Hyperlipidaemia is an important risk factor for cardiovascular disease in renal transplant recipients. The aim of this study was to test the efficacy and possible drug-drug interactions of the new HMG-CoA reductase inhibitors (statins) atorvastatin and cerivastatin in cyclosporin A (CsA)-treated renal transplant patients. Subjects and methods. Thirty patients with stable graft function and LDL cholesterol of 130 mg/dl were randomly assigned to active treatment groups (10 mg atorvastatin or 0.2 mg cerivastatin), or a control group. CsA blood trough levels were controlled on a weekly basis and adapted if they changed more than 25% from baseline values (100-150 ng/ml). Lipid levels and routine laboratory parameters before and after a treatment period of 3 months were compared.

A decrease (dip) in blood pressure during sleep occurs in normal people and in patients with uncomplicated essential hypertension. Failure to identify such a dip suggests additional pathology, which makes the identification of "nondippers" important. Rigid definitions of nocturnal time periods (eg, night is defined as lasting from 22:01 to 06:00) to identify dippers and nondippers has been used for over a decade. However, these definitions may not correspond to actual sleep patterns, and thus may lead to faulty interpretations. We investigated whether or not an analysis of ambulatory blood pressure (BP) profiles according to the patients' individual reported awake/sleep pattern would result in an improved categorization of dippers and nondippers. Four groups of patients were investigated: normotensive volunteers, borderline hypertensive patients, essential hypertensive patients, and renal transplant recipients. In all four groups, blood pressure (systolic and diastolic) decreased to a greater degree when the individual reports were employed, compared to the fixed patterns. For systolic BP this difference (individualized v fixed 06:01 to 22:00 day and 22:01 to 06:00 night) amounted to 17.6 +/- 5.0 v 13.2 +/- 5.4 mm Hg for normotensive subjects, 18.5 +/- 6.0 v 11.7 +/- 8.6 mm Hg for borderline hypertensive subjects, 17.7 +/- 10.6 v 12.9 +/- 10.4 mm Hg for essential hypertensive patients, and 8.6 +/- 11.3 v 6.5 +/- 9.8 mm Hg in renal transplant patients (all P < .05). Individualized awake/sleep reports resulted in a better classification of dippers and nondippers, since misclassifications due to divergent sleep patterns (mainly going to bed late) were avoided.

To provide an update on the ability of different antihypertensive drugs to reduce left ventricular hypertrophy in essential hypertension.

To determine the effects of circadian variation in arterial pressure on early hypertensive target organ disease, we examined systemic hemodynamics (cardiac output by indocyanine green dye dilution), renal hemodynamics (renal plasma flow by iodine-131 para-aminohippuric acid clearance), left ventricular structure and function (2D-guided M-mode echocardiogram), and 24-h ambulatory blood pressure in 20 women and 46 men with untreated essential hypertension. Both gender groups were subdivided into "dippers" and "nondippers" according to the physiologic nocturnal decrease in mean arterial pressure by 10% of daytime values. Systemic and renal hemodynamics, neurohumoral findings (norepinephrine, epinephrine, dopamine, plasma renin activity), causal blood pressure values, duration of hypertension, and body weight did not differ between the two groups. In contrast, left ventricular mass and mass index was higher in female nondippers than dippers (255 +/- 68 v 184 +/- 81 g, and 137 +/- 30 v 102 +/- 39 g/m2, P < .05, respectively), while in men no significant differences were found (234 +/- 48 v 240 +/- 54 g, and 119 +/- 27 v 121 +/- 13 g/m2, P = NS, respectively). Relative wall thickness (0.45 +/- 0.06 v 0.39 +/- 0.06, P < .05) and posterior wall thickness (1.1 +/- 0.1 v 0.89 +/- 0.2 mm, P < .05) were also found to be greater in female nondippers than in dippers, whereas no significant differences were obtained in men. Thus, the degree of left ventricular hypertrophy correlated with the circadian blood pressure variations in women only, which indicates that left ventricular structure may be more load-dependent in women than in men with essential hypertension.

Angiotensin (Ang) II modulates cardiovascular baroreflexes; whether or not the peptide influences chemosensitive cardiovascular reflexes is not known. We tested the hypothesis that Ang II modulates the reflex control of sympathetic nerve activity exerted by 5‐hydroxytryptamine 3 (5HT3) cardiopulmonary receptors.The 5HT3receptor agonist phenylbiguanide (PBG), infused intravenously for 15 min, elicited a sustained reflex decrease of renal sympathetic nerve activity (RSNA) but only transient (<3 min) changes of arterial blood pressure (BP) and heart rate (HR) in methohexital‐anaesthesized rats.Infusion of Ang II at a dose that did not affect baseline BP, HR and RSNA enhanced the PBG‐evoked reflex decrease of RSNA (−54±5% in Ang II treated versus −33±6% in control rats after 15 min PBG, P<0.05, n= 6 each) in methohexital‐anaesthetized rats.The angiotensin converting enzyme (ACE) inhibitor lisinopril blunted the reflex responses to PBG in anaesthetized as well as conscious animals. The effect of the ACE inhibitor was abolished by concomitant infusion of Ang II.The reflex response to stimulation of cardiopulmonary 5HT3afferents was also impaired by the Ang II type 1 receptor (AT1) blocker ZD7155 but not by the type 2 (AT2) blocker PD 123319.Infusion of a volume load to stimulate cardiopulmonary baroreceptors induced a gradual decrease of RSNA which was impaired by exogenous Ang II (RSNA −26±6% in Ang II treated versus −47±6% in control rats after volume load, P<0.05, n= 6 each) but unaffected by ACE inhibition.The reflex control of RSNA by cardiopulmonary 5HT3receptors is enhanced by Ang II viaAT1receptors. Thus, Ang II facilitates a chemosensitive cardiovascular reflex, in contrast to its inhibitory influences on mechanosensitive reflexes.

Obstructive sleep apnea (OSA) is associated with sympathetic nervous system activation and the development of hypertension. The Global SYMPLICITY Registry is prospectively enrolling real world patients with uncontrolled hypertension including patients with OSA. This analysis compares baseline characteristics and blood pressure (BP) lowering effects of renal denervation in patients with and without OSA.