Manejo terapéutico farmacológico actual en la hipertensión arterial sistémica del adulto
Palabras clave:
hipertensión esencial, antihipertensivos - efectos adversos
Resumen
El tratamiento con agentes farmacológicos de la hipertensión arterial sistémica (HTA) produce una disminución significativa de las complicaciones cardiovasculares. La terapia antihipertensiva farmacológica produce una reducción del riesgo relativo de casi 50% en la incidencia de insuficiencia cardíaca, una reducción del riesgo relativo de ictus de hasta 40%, y de hasta 25% de reducción del riesgo relativo en el infarto de miocardio. El grado de reducción de la presión arterial, no la elección de la medicación antihipertensiva, es el principal determinante de la reducción del riesgo cardiovascular en pacientes con HTA. La terapia de combinación con fármacos de diferentes clases tiene un efecto de reducción de la presión arterial sustancialmente mayor que la duplicación de la dosis de un solo agente. Sin embargo, el riesgo de efectos adversos, costos e inconvenientes para el paciente aumentan a medida que se agregan más medicamentos antihipertensivos. El objetivo es realizar una revisión narrativa sobre el manejo terapéutico farmacológico actual de la HTA del adulto.
Citas
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https://www.revistaspmi.org.py/index.php/rvspmi/article/view/22/22
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3. Bress AP, Tanner RM, Hess R, Colantonio LD, Shimbo D, Muntner P. Generalizability of SPRINT results to the US adult population. J Am Coll Cardiol. 2016; 67(5):463-472. doi:10.1016/j.jacc.2015.10.037.
4. Cheung BMY, Or B, Fei Y, Tsoi MF. A 2020 vision of hypertension. Korean Circ J. 2020; 50(6):469-475. https://doi.org/10.4070/kcj.2020.0067.
5. Ramirez MO, Pino CT, Furiasse LV, Lee AJ, Fowkes FG. Paraguayan national blood pressure study: prevalence of hypertension in the general population. J Hum Hypertens. 1995; 9(11):891-897.
6. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360 (9349): 1903-13. https://doi.org/10.1016/s0140-6736(02)11911-8.
7. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311(5):507-20. https://doi.org/10.1001/jama.2013.284427.
8. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365(9455):217-23. https://doi.org/10.1016/s0140-6736(05)17741-1.
9. Ortellado Maidana J, Ramirez A, Gonzalez G, Olmedo Filizzola G, Ayala de Doll M, Sano M, et al. Consenso paraguayo de hipertensión arterial 2015. Rev. virtual Soc. Parag. Med. Int /Internet/. 2016 /citado 19 Feb 2020/; 3(2):11-57.Disponible en: http://scielo.iics.una.py/pdf/spmi/v3n2/v3n2a02.pdf.
Doi:10.18004/rvspmi/2016.03(02)11-0572312-3893/
10. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb ChD 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: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018; 138(17):e426-e483. https://doi.org/10.1161/CIR.0000000000000597.
11. Beevers G, Lip GY, O'Brien E. ABC of hypertension: Blood pressure measurement. Part II-conventional sphygmomanometry: technique of auscultatory blood pressure measurement. BMJ. 2001; 322(7293): 1043-7. https://doi.org/10.1136/bmj.322.7293.1043.
12. Myers MG. A proposed algorithm for diagnosing hypertension using automated office blood pressure measurement. J Hypertens. 2010; 28(4): 703-8. https://doi.org/10.1097/hjh.0b013e328335d091.
13. Forman JP, Stampfer MJ, Curhan GC. Diet and Lifestyle Risk Factors Associated With Incident Hypertension in Women. JAMA. 2009; 302(4): 401-11. https://doi.org/10.1001/jama.2009.1060.
14. Berger-Klein J. What's new in the ESC 2018 guidelines for arterial hypertension: The ten most important messages. Wien Klin Wochenschr. 2019; 131(7-8):180-185. https://doi.org/10.1007/s00508-018-1435-8.
15. Mansfield KE, Nitsch D, Smeeth L, Bhaskaran K, Tomlinson LA. Prescription of renin-angiotensin system blockers and risk of acute kidney injury: a population-based cohort study. BMJ Open. 2016; 6(12): e012690. doi:10.1136/bmjopen-2016-012690.
16. Fei Y, Tsoi MF, Cheung BM. Determining the optimal systolic blood pressure for hypertensive patients: a network meta-analysis. Can J Cardiol. 2018; 34(12):1581-9. https://doi.org/10.1016/j.cjca.2018.08.013.
17. Gulla C, Flo E, Kjome RL, Husebo BS. Deprescribing antihypertensive treatment in nursing home patients and the effect on blood pressure. J Geriatr Cardiol. 2018; 15(4):275-83. https://doi.org/10.11909/j.issn.1671-5411.2018.04.011.
18. García Bello LB, Pederzani LM, Fretes A, Centurión OA. Características clínicas de los pacientes con crisis hipertensivas que acuden a un Servicio de emergencias médicas. Rev. virtual Soc. Parag. Med. Int /Internet/. 2020 /citado 20 Feb 2020/; 7 (1):42-9. Disponible en:
https://www.revistaspmi.org.py/index.php/rvspmi/article/view/154/157
https://doi.org/10.18004/rvspmi/2312-3893/2020.07.01.42-049.
19. Calhoun DA, Booth JN, Oparil S, Irvin MR, Shimbo D, Lackland DT, et al. Refractory hypertension: determination of prevalence, risk factors, and comorbidities in a large, population-based cohort. Hypertension. 2014; 63(3):451–8. https://doi.org/10.1161/hypertensionaha.113.02026.
20. Alderete Martínez JF, Centurión OA. Etiopatogenia e implicancia pronóstica en el infarto de miocardio sin obstrucción de las arterias coronarias epicárdicas (MINOCA). Rev. virtual Soc. Parag. Med. Int /Internet/. 2020 /citado 19 Feb 2020/; 7(1):86-95. Disponible en:
https://www.revistaspmi.org.py/index.php/rvspmi/article/view/159/162.
https://doi.org/10.18004/rvspmi/2312-3893/2020.07.01.86-095.
21. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017; 166(6):430-7. https://doi.org/10.7326/M16-1785.
22. Chavez Alonso CO, Centurión OA. Conceptos epidemiológicos, manejo diagnóstico y farmacológico de la insuficiencia cardiaca congestiva crónica. Rev. virtual Soc. Parag. Med. Int /Internet/. 2019 /citado 18 Feb 2020/; 6 (1):75-85. Disponible en:
https://www.revistaspmi.org.py/index.php/rvspmi/article/view/22/22
23. He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013; 346: f1325. https://doi.org/10.1136/bmj.f1325.
24. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006; 47(2): 296-308. https://doi.org/10.1161/01.HYP.0000202568.01167.B6.
25. Gupta R, Yusuf S. Towards better hypertension management in India. Indian J Med Res /Internet/. 2014 /cited 2020 Feb 10/; 139(5):657–60. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4140027/
26. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008; 117(25):e510–26. https://doi.org/10.1161/circulationaha.108.189141.
27. van der Wardt V, Harrison JK, Welsh T, Conroy S, Gladman J. Withdrawal of antihypertensive medication: a systematic review. J Hypertens. 2017; 35(9):1742-9. https://doi.org/10.1097/HJH.0000000000001405.
28. Sieg-Dobrescu D, Burnier M, Hayoz D, Brunner HR, Waeber B. The return of increased blood pressure after discontinuation of antihypertensive treatment is associated with an impaired post-ischemic skin blood flow response. J Hypertens. 2001; 19(8):1387-92. https://doi.org/10.1097/00004872-200108000-00006.
29. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Rohm Young D, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006; 144(7): 485-95. https://doi.org/10.7326/0003-4819-144-7-200604040-00007.
30. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31(7): 1281-357. https://doi.org/10.1097/01.hjh.0000431740.32696.cc
31. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289(19): 2560-72. https://doi.org/10.1001/jama.289.19.2560.
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