Comentarios del artículo In The Clinic: Screening and prevention, diagnosis, and treatment of hypertension
Resumen
En el último tiempo se han publicado en el mundo diferentes guías de diagnóstico y tratamiento de la hipertensión arterial, con algunas modificaciones al respecto de las previas (1-5). Las mismas han presentado algunas discrepancias entre ellas, inclusive en relación a los valores umbrales de presión arterial (PA) para definir al paciente como hipertenso. Por otro lado, estas diferencias se evidencian tanto en la clasificación en grados según los valores de PA, como también en lo que respecta a las metas u objetivos terapéuticos propuestos. Esto se debe en gran parte a que el balance entre riesgo y beneficio del tratamiento en función de estos límites fue objeto de estudio y discusión durante los últimos años (6-10).
Citas
1. William B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33):3021-3104.
2. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 71(19):e127–e248.
3. Task Force of the Latin American Society of Hypertension. Guidelines on the management of arterial hypertension and related comorbidities in Latin America. J Hypertens. 2017; 35(8):1529-45.
4. Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018; 34(5):506-25.
5. Sabio R, Valdez P, Abuabara Turbay Y, Andrade Belgeri RE, Arbo Oze de Morvil GA, Arias C, et al. Recomendaciones latinoamericanas para el manejo de la hipertensión arterial en adultos (RELAHTA 2). Rev virtual Soc. Parag. Med. Int. 2019; 6 (1):86-123
6. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387(10022):957-67.
7. Brunström M, Carlberg B. Association of Blood Pressure Lowering with mortality and cardiovascular disease across blood pressure levels: A systematic review and meta-analysis. JAMA Intern Med. 2018; 178(1):28-36.
8. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017; 317(2):165–82.
9. Weber MA, Poulter NR, Schutte AE, Burrell LM, Horiuchi M, Prabhakaran D, et al. Is It time to reappraise blood pressure thresholds and targets? A statement from the International Society of Hypertension—A global perspective. Hypertension. 2016; 68(2):266–268.
10. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials. J Hypertens. 2016; 34(4): 613–22.
11. Byrd JB, Brook RD. Hypertension. Ann Intern Med. 2019; 170(9):ITC65-ITC80.
12. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr, Whelton PK. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. J Am Coll Cardiol. 2018; 71(2):109-18.
13. Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373(22): 2103-16.
14. Gijón Conde T, Gorostidic M, Camafortd M, Abad-Cardiel M, Martín-Rioboof E, Morales-Olivasg F. Spanish Society of Hypertension position statement on the 2017 ACC/AHA hypertension guidelines. Hipertens Riesgo Vasc. 2018; 35(3): 119-29.
15. Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018; 378(16):1509-20.
16. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003; 24(11):987–1003.
17. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–81.
18. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129(25 suppl 2):S1–S45.
19. Karmali KN, Lloyd-Jones DM, van der Leeuw J, Goff DC Jr, Yusuf S, Zanchetti A, et al. Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data. PLoS Med. 2018; 15(3):e1002538.
20. Sundstrom J, Arima H, Woodward M, Jackson R, Karmali K, Lloyd-Jones D, et al. Blood pressure lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet. 2014; 384(9943):591–8.
21. Zhao D, Liu J, Xie W, Qi Y. Cardiovascular risk assessment: a global perspective. Nat Rev Cardiol. 2015; 12(5):301-11.
22. Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet. 2016; 387(10013):61–9.
2. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 71(19):e127–e248.
3. Task Force of the Latin American Society of Hypertension. Guidelines on the management of arterial hypertension and related comorbidities in Latin America. J Hypertens. 2017; 35(8):1529-45.
4. Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, et al. Hypertension Canada’s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018; 34(5):506-25.
5. Sabio R, Valdez P, Abuabara Turbay Y, Andrade Belgeri RE, Arbo Oze de Morvil GA, Arias C, et al. Recomendaciones latinoamericanas para el manejo de la hipertensión arterial en adultos (RELAHTA 2). Rev virtual Soc. Parag. Med. Int. 2019; 6 (1):86-123
6. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016; 387(10022):957-67.
7. Brunström M, Carlberg B. Association of Blood Pressure Lowering with mortality and cardiovascular disease across blood pressure levels: A systematic review and meta-analysis. JAMA Intern Med. 2018; 178(1):28-36.
8. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017; 317(2):165–82.
9. Weber MA, Poulter NR, Schutte AE, Burrell LM, Horiuchi M, Prabhakaran D, et al. Is It time to reappraise blood pressure thresholds and targets? A statement from the International Society of Hypertension—A global perspective. Hypertension. 2016; 68(2):266–268.
10. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels - updated overview and meta-analyses of randomized trials. J Hypertens. 2016; 34(4): 613–22.
11. Byrd JB, Brook RD. Hypertension. Ann Intern Med. 2019; 170(9):ITC65-ITC80.
12. Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr, Whelton PK. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. J Am Coll Cardiol. 2018; 71(2):109-18.
13. Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015; 373(22): 2103-16.
14. Gijón Conde T, Gorostidic M, Camafortd M, Abad-Cardiel M, Martín-Rioboof E, Morales-Olivasg F. Spanish Society of Hypertension position statement on the 2017 ACC/AHA hypertension guidelines. Hipertens Riesgo Vasc. 2018; 35(3): 119-29.
15. Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018; 378(16):1509-20.
16. Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003; 24(11):987–1003.
17. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–81.
18. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129(25 suppl 2):S1–S45.
19. Karmali KN, Lloyd-Jones DM, van der Leeuw J, Goff DC Jr, Yusuf S, Zanchetti A, et al. Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data. PLoS Med. 2018; 15(3):e1002538.
20. Sundstrom J, Arima H, Woodward M, Jackson R, Karmali K, Lloyd-Jones D, et al. Blood pressure lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet. 2014; 384(9943):591–8.
21. Zhao D, Liu J, Xie W, Qi Y. Cardiovascular risk assessment: a global perspective. Nat Rev Cardiol. 2015; 12(5):301-11.
22. Khatib R, McKee M, Shannon H, Chow C, Rangarajan S, Teo K, et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data. Lancet. 2016; 387(10013):61–9.
