In Reply

[摘要] The pathophysiology of arterial hypertension is multifactorial. We could not consider all mechanisms ( 1 ). Unfortunately, the individual mechanisms that cause a rise in blood pressure usually cannot be identified. Our colleague Dr. Swalve-Bordeaux points out that blood pressure in postmenopausal women often increases and suggests that this increase in blood pressure should be counteracted with estrogen replacement. We consider this proposal to be extremely problematic, as recent meta-analyses of large clinical trials have shown that estrogen administration (with or without progesterone) in the context of primary prevention provides minor benefits in some areas, yet increases serious complications in others ( 2 ). For instance, receiving only estrogens increases the risk of stroke. In contrast, antihypertensive therapy has been clearly proven to reduce the risk of stroke. The comment that sleep deprivation is an underestimated risk factor for arterial hypertension is supported by epidemiological studies ( 3 ). We consider the decrease in mean sleep duration in many countries to be alarming. A form of secondary hypertension should be considered especially for patients with early onset hypertension, blood pressure that remains uncontrolled, or suspicious concomitant clinical symptoms and findings. Prof. Koch reminds us that these rarer diseases can have an atypical presentation. We should always subject clinical diagnoses—whether for hypertension or any other area of clinical medicine—to regular review. However, an untargeted search for cause in all patients with hypertension cannot be recommended.

[学科分类] 医学（综合）