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Hipertensión Arterial 2014 - Leandro
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HIPERTENSIÓN ARTERIAL
Oswaldo Leandro Nina Cueva2010 - 10540
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DEFINICIÓN
sustained elevation of systemic arterial blood pressure, most commonly defined as systolic blood pressure (SBP) ≥ 140 mm
Hg or diastolic blood pressure (DBP) ≥ 90 mm Hg
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DIAGNOSTICO
Diagnosis of hypertension should be based on ≥ 2 blood pressure measurements per visit on ≥ 2 visits (ESH/ESC Class I, Level C)(4)
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DEFINICIÓN Y CLASIFICACIÓN
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CRISIS HIPERTENSIVAS
Las crisis hipertensivas se definen como una elevación aguda de la presión arterial capaz de llegar a producir alteraciones
estructurales o funcionales en diferentes órganos.
Crisis hiperténsiva: Pacientes con PAS> 179 ó PAD> 109 mmHg. JNC 7.
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ESTRATIFICACIÓN DE RIESGO
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TOMA DE LA PRESIÓN ARTERIAL EN CONSULTA
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DX DIFERENCIALES
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DX DIFERENCIALES
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TRATAMIENTO
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NICE
El diagnóstico de HTA primaria o esencial debe ser confirmado con MAPA o AMPA como gold standard
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NICE
Antes de asociar una segunda droga, debe aumentarse la dosis de la primera.
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NICE – OBJETIVOS DE LA P.A.
En consulta:
< 80 años: < 140/90
> 80 años: < 150/90
Media de la MAPA o AMPA:
< 80 años: < 135/85 > 80 años: < 145/85
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HTA aislada (TA objetivo < 140/90):
• Fármacos 1ª línea: todos excepto a-bloq, BB (> 60 años)
• Monoterapia > Combinación
Diabetes Mellitus (TA objetivo < 130/80):
• iECAS o ARA II
• iECAS o ARA II + CalAnt
El objetivo de TA cercano a 130 y a 80
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ESH/ESC GUIDELINES
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ESH/ESC GUIDELINES - INDIVIDUALIZACIÓN
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ESH/ESC GUIDELINES - INDIVIDUALIZACIÓN
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ESH/ESC GUIDELINES - CONVINACIONES
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JAMA – RECOMENDACIONES
In General nonblack population, including those with diabetes
•Initial antihypertensive treatment should include any of the following:
A thiazide-type diuretic Calcium channel blocker (CCB) Angiotensin-converting enzyme inhibitor (ACEI) or Angiotensin receptor blocker (ARB).
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JAMA – RECOMENDACIONES
In general black population, including those with diabetes:
•Initial antihypertensive treatment should include :
Thiazide-type diuretic CCB.
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JAMA – RECOMENDACIONES
Population aged 18 years or older with CKD and hypertension
•Initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes.
•This applies to all CKD patients with hypertension regardless of race or diabetes status.
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JAMA – RECOMENDACIONES
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EN RESUMEN:No Raza Negra / <55años / ERC / DM /
Coronary artery diseases De Raza Negra / >55años
IECA:• Captopril: 25 – 150 mg/d, dividido en 3
dosis• Enalapril: 2.5 – 40 mg/d, dividido en 2
dosis
ARA-II:• Irbersartan: 150 – 300 mg/d • Losartan: 25 – 100 mg/d, 1 dosis o 2
dosis• Valsaltran: 80 – 32 mg/d
CCB:• Amlodipino: 2.5 – 1 mg/d• Nifedipino: 20mg/12h• Verapamilo: 120 – 360 mg/d
Thiazidas: • Hidroclorotiazida: 12.5 – 50 mg/d
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EN RESUMEN:
Hipertensión con Angina de Pecho:B-bloquers: metoprolol (50 – 1 mg/d), atenolol (25 – 100 mg/d)
CCB
Hipertension con embarazo:Metildopa (250 mg/3vces dia) B-bloquersCCB
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EN RESUMEN:
Aspirin
low-dose aspirin suggested in patients with hypertension at high risk for cardiovascular disease
for primary prevention of cardiovascular disease in patients with hypertension, aspirin reduces myocardial infarction, increases bleeding, and does not reduce strokes or total cardiovascular events
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EN RESUMEN:
consider statins for patients at increased risk for cardiovascular disease
statins reduce cardiovascular disease events and stroke and may reduce all-cause mortality in patients without known cardiovascular disease, and reduce mortality and cardiovascular events in patients with cardiovascular disease
absolute benefit from statins for primary prevention of heart disease depends more on overall risk than cholesterol levels