hta en grupos especiales

7/25/2019 HTA en Grupos Especiales

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TRATAMIENTO DE HTA EN GRUPOSTRATAMIENTO DE HTA EN GRUPOSESPECIALESESPECIALES

DRA MARITZA ROSALES VIDALDRA MARITZA ROSALES VIDALINCOR ESSALUDINCOR ESSALUD


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Presi,n ,r(ic cen(r# "s &r7ui#Presi,n ,r(ic cen(r# "s &r7ui#8Son igu#es98Son igu#es9

L 2resi,n ,r(ic cen(r#-L 2resi,n ,r(ic cen(r#-: P &r7ui# ; P1 ,r(ic usu#men(eP &r7ui# ; P1 ,r(ic usu#men(e

: J,"enes- P1 &r7ui# ; P1 ,r(icJ,"enes- P1 &r7ui# ; P1 ,r(ic

: eriores #osc#cion(gonis(sc#cion(gonis(sen e# con(ro# !een e# con(ro# !e2resi,n ,r(ic cen(r#)2resi,n ,r(ic cen(r#)

)CA3E s(u!01 Circu#(ion ?@@1 - ??


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8A 7uiFnes (r(r98A 7uiFnes (r(r9

8Pre i2er(ensi,n o norm# #(o98Pre i2er(ensi,n o norm# #(o9

8M4s &'o me'or98M4s &'o me'or9


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Pre Hi2er(ensi,n o Norm#es A#(osPre Hi2er(ensi,n o Norm#es A#(osMne'oMne'o

Riesgo cr!io"scu#rRiesgo cr!io"scu#rinici con mmHginici con mmHg

E# (r(mien(o con BRAE# (r(mien(o con BRA

$cn!esr(n* re(r! #$cn!esr(n* re(r! #2rici,n !e HTA es(!io I1)/))2rici,n !e HTA es(!io I1)/))

BENE3ICIO-BENE3ICIO-: Tr(mien(o !e 2cien(es con 2resi,n #( norm# 0 !i&e(es oTr(mien(o !e 2cien(es con 2resi,n #( norm# 0 !i&e(es o

n(ece!en(es !e ECV o EAC)))n(ece!en(es !e ECV o EAC)))

)THROPH1 Ju#ius1 3esi&i#i(0 o> (re(ing 2re02er(ension K(i ngi(ensin rece2(or B#ocer1 NEJM ?@@- ))PHARAO1 Anon1 S(u!0 o> (e H02er(ension Legue1 Cn De"e#o2men( o> H02er(ension Ki( ARB13or(scr Me! ?@@@ ?- )))Messere#i1 Essen(i# H02er(ension1 Lnce( ?@@- @

PASPAS PADPAD

JNC JNC ?@?@ @@

ESCESC @@


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8A 7uiFnes (r(r98A 7uiFnes (r(r9

8Pre i2er(ensi,n o norm#8Pre i2er(ensi,n o norm#

#(o9#(o98M4s &'o me'or98M4s &'o me'or9


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8E5is(e # Cur" J98E5is(e # Cur" J9Pun(o !e 2resi,n !is(o#ic !e&'o !e# cu#Pun(o !e 2resi,n !is(o#ic !e&'o !e# cu#

umen(n e# riesgo CV1umen(n e# riesgo CV1: PAD =@ mmHg 2oci,n gener#PAD =@ mmHg 2oci,n gener#))/ riesgo 5?/ riesgo 5?))))

: PAD =@ mmHg en !i&F(icos1PAD =@ mmHg en !i&F(icos1))

: PAD =@ mmHg riesgo 5PAD =@ mmHg riesgo 5))))

: PAD =mmHgPAD =mmHg)))))) en ECV con(ro"ersi#1en ECV con(ro"ersi#1PAD &'- # mor(#i!! umen( (n(o enPAD &'- # mor(#i!! umen( (n(o en(r(!os como en no (r(!os1 8E52resi,n !e(r(!os como en no (r(!os1 8E52resi,n !econ!ici,n !e s#u!9con!ici,n !e s#u!9QQ

Pru!enci# mn(ener PAD;@mmHg en #(oPru!enci# mn(ener PAD;@mmHg en #(oriesgo1riesgo1QQ

)HOT1 H02er(ension O2(im# Tre(men(1 Lnce( - ?))INVEST1In(ern(ion# Ver2mi#Trn!ro#2ri# Tri#1 Ann In(er me! ?@@-)))Sones1 Arc In(er Me! - - ?@@?@@1QRosen!or>>1 Tre(men( o> H02er(ension in Iscemic er( !isese1 Circ ?@@-??


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ANCIANOSANCIANOS

Renin/ sensi&i#i!! s#Renin/ sensi&i#i!! s#

Dosis &'sDosis &'s

Vigi#r e>ec(o me(&o#ico !iure(icoVigi#r e>ec(o me(&o#ico !iure(icoCrCr


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RAZA NEGRARAZA NEGRA

A#(


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EN3ERMEDAD CEREBROEN3ERMEDAD CEREBRO

VASCULARVASCULAR


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EN3ERMEDAD CEREBROEN3ERMEDAD CEREBROVASCULAR e HTAVASCULAR e HTA

mi##ones+o mi##ones+o!e!e 2ersons2ersonssu>ren EVCsu>ren EVC

L 2resi,n r(eri#L 2resi,n r(eri#: Es e# 2re!ic(or m4s 2o!eroso !e ECV1)Es e# 2re!ic(or m4s 2o!eroso !e ECV1)

: P(r,n no !i22er es 2re!ic(or !e ECV1))P(r,n no !i22er es 2re!ic(or !e ECV1)): Hi2er(ensi,n m(u(inHi2er(ensi,n m(u(in mmHg $(o2 !ec#ine*)))mmHg $(o2 !ec#ine*)))

)Hi>eng Zng1 B#oo! Pressure LoKering >or Primr0 n! Secun!r0 Pre"en(ion o> S(roe1 H02er(ension1 ?@@- ))OBrien1 Di22ers n! non !i22ers1 Lnce( ii- )))6rio1 Morning Surge in oo! 2resure s 2re!ic(or o> si#en( n! c#inic# cere&ro"scu#r !isese in e!er#002er(ensi"es1 Circ ?@@ @- @@


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Re#ci,n e!!2resi,n r(eri# conRe#ci,n e!!2resi,n r(eri# conmor(#i!! 0 s(roemor(#i!! 0 s(roe

Mortalidad por stroke Stroke fatal y no fatal

Hi>eng Zng1 B#oo! Pressure LoKering >or Primr0 n! Secun!r0 Pre"en(ion o> S(roe1H02er(ension1 ?@@ -


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Mne'o !e i2er(ensi,n r(eri# enMne'o !e i2er(ensi,n r(eri# enECVECV

Pre"enci,nPre"enci,n: Primri c#cio n(gonis(s ARAPrimri c#cio n(gonis(s ARA

: Secun!riSecun!ri

Mne'o gu!o !e ECVMne'o gu!o !e ECV: Is7uFmicoIs7uFmico

: Hemorr4gico PA no menor @@Hemorr4gico PA no menor @@


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Pre"enci,nPre"enci,n

Primri ECVPrimri ECV

Diure(icosBB

Hi>eng Zng1 B#oo! Pressure LoKering >or Primr0 n! Secun!r0 Pre"en(ion o> S(roe1 H02er(ension1 ?@@ -

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IEC

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ECV PREVENCION PRIMARIAECV PREVENCION PRIMARIA

Disminuci,n !e Presi,n r(eri#-Disminuci,n !e Presi,n r(eri#-: Dis(o#ic en mmHg en +os-Dis(o#ic en mmHg en +os- @ ECV)@ ECV): Sis(o#ic en @ mmHg en +os-Sis(o#ic en @ mmHg en +os- @ ECV))@ ECV))

LosLos c#cion(gonis(sc#cion(gonis(s00 BRABRAmues(rnmues(rn&ene>icio so&re &e(o7ue!ores 0&ene>icio so&re &e(o7ue!ores 0!iurF(icos1!iurF(icos1

Los IECAS no n !emos(r!o &ene>icioLos IECAS no n !emos(r!o &ene>icio>ren(e o(ros >4rmcos1>ren(e o(ros >4rmcos1

)Co##ins- B#oo! 2ressure/ n(i02er(ensi"e !rug (r(men( n! (e riss o> s(roe n! o> CHD1 Br Me! Bu##1 @-???

))SHEP1 Sis(o#0c 02er(ension in e!er#0 2rogrm1 JAMA1 ?@@@ ?-


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PREVENCION

SECUNARIA


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BENE3ICIO-BENE3ICIO-

8Por # c#se !e n(ii2er(ensi"o8Por # c#se !e n(ii2er(ensi"o

ooe# gr!o !e !isminuci,n !e PA9e# gr!o !e !isminuci,n !e PA9


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PREVENCION DE ECVPREVENCION DE ECV

E# m0or !e(erminn(e es # !isminuci,nE# m0or !e(erminn(e es # !isminuci,n!e 2resi,n r(eri#1!e 2resi,n r(eri#1

)JNC1 JAMA ?@@ ?- ?@??

)) ESC ESH1 ?@@ Gui!e#ines >or (e mngemen( o> r(eri# 02er(ension1 Euro2enHer( Journ# ?@@1 ?/ ?

PA o&'e(i"oPA o&'e(i"o TERAPIATERAPIA

JNC )JNC )Ter2i com&in!Ter2i com&in!2erin!o2ri# Q HCTZ2erin!o2ri# Q HCTZ

ESC))ESC)) =@@=@@ Cu#7uier n(iHTACu#7uier n(iHTA


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EVENTO CEREBRO VASCULAR AGUDOEVENTO CEREBRO VASCULAR AGUDO

S/ isr1 Acu(e 02er(ension in in(rcere&r# emorrge- P(o20sio#og0 n! (re(men(1Journ# o> Te Neuro#ogic# Sciencies ? $?@@*

E# !e ECV gu!osE# !e ECV gu!os2resen(n PAS @mmHg2resen(n PAS @mmHg

PRESION DE PER3USIONPRESION DE PER3USIONCEREBRALCEREBRAL$PPC* se$PPC* se

u(oregu#u(oregu#

si PAM @@mmHgsi PAM @@mmHg

!IBERNACION REPER"USION NORMALI#ACION

$%& IAS &%'( IAS )&SEM

MANEJO ECV 4 iMANEJO ECV 4 i


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MANEJO ECV emorr4gicoMANEJO ECV emorr4gicoRecomen!ciones AHA/ ASARecomen!ciones AHA/ ASA

Re!ucci,n !e#Re!ucci,n !e# PAM PAMno #(er e# >#u'o !e 2er>usi,nno #(er e# >#u'o !e 2er>usi,n

cere&r#cere&r#Mn(enerMn(ener PAM @@mmHg)PAM @@mmHg)$AHA* 0 PPC ;@mmHG))$AHA* 0 PPC ;@mmHG))

)Bro!eric1Gui!e#ines >or (e mngemen( o> s2on(neous in(rcere&r# emorrge1 AHA1S(roe @$*- @

))Bro!eric e( #1Gui!e#ines >or (e mngemen( o> s2on(neous in(rcere&r# emorrge1S(roe ?@@- ?@@?@?

PASPAS PAMPAM PPCPPC MANE*OMANE*O

)&$$)&$$ )'+$)'+$ Inf,si-nInf,si-n

)'.$)'.$ )'/$)'/$ 00Monitoreo PPCMonitoreo PPC

Mantener 1$%.$22!3Mantener 1$%.$22!3

)'.$)'.$ '/$'/$ Nor2alNor2al PAM ''$ - PA '1$45$22!3PAM ''$ - PA '1$45$22!3

M !i i, ! ECV


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Me!icci,n en!o"enos1 ECVMe!icci,n en!o"enos1 ECVemorr4gicoemorr4gico

DROGADROGA EV BOLOEV BOLO IN3USIONIN3USION

L&e(#o#L&e(#o# ?@mg cmin?@mg cmin?mgmin $m5?mgmin $m5@@mg!*@@mg!*

Nicr!i2ineNicr!i2ine mgmgEsmo#o#Esmo#o# ?@Ugg?@Ugg ?@@ uggmin?@@ uggmin

EnalaprilEnalapril @1?mg c@1?mg c

H0!r#.ineH0!r#.ine ?@mg c@min?@mg c@min 1 uggmin1 uggminNi2ri!eNi2ri!e @1@ uggmin@1@ uggmin

Nitro3li6erinaNitro3li6erina ?@@@ ugmin?@@@ ugmin

Bro!eric e( #1 Gui!e#ines >or (e mngemen( o> s2on(neous in(rcere&r# emorrge1S(roe ?@@- ?@@?@?


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Mne'o ECV is7uFmicoMne'o ECV is7uFmico

O&'e(i"o-O&'e(i"o-: Re!ucci,n !e >ormci,n !e e!em cere&r#1Re!ucci,n !e >ormci,n !e e!em cere&r#1

: Disminuci,n !e riesgo !e (rns>ormci,nDisminuci,n !e riesgo !e (rns>ormci,nemorr4gic !e# in>r(o1emorr4gic !e# in>r(o1

: E"i(r m0or !+o "scu#rE"i(r m0or !+o "scu#r


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ECV ISUEMICOECV ISUEMICORECOMENDACIONES AHAASA ?@@RECOMENDACIONES AHAASA ?@@

E6G inici# 2or #( >recuenci !e en>1 CV $I&*E6G inici# 2or #( >recuenci !e en>1 CV $I&*Mne'o !e HTA en e"en(o gu!o (m&iFnMne'o !e HTA en e"en(o gu!o (m&iFncon(ro"ersi#con(ro"ersi#11

Disminuci,n !eDisminuci,n !e PA en PA en #s 2rimers ?rs1#s 2rimers ?rs1Inicio siInicio si PAS;??@ o PAD;?@ mmHgPAS;??@ o PAD;?@ mmHg1 $IC*1 $IC*Mne'o !e i2er(ensi,n siMne'o !e i2er(ensi,n si PAS; o PAD;@PAS; o PAD;@mmHg 2r inicio !e rTPA1$IB*mmHg 2r inicio !e rTPA1$IB*

Mn(ener PA = @@ mmHg #uego !e inicioMn(ener PA = @@ mmHg #uego !e inicio!e rTPA $I*!e rTPA $I*E#ecci,n !e (r(mien(o es 2or consenso1$II*E#ecci,n !e (r(mien(o es 2or consenso1$II*

Hro#! e( #1 Gui!e#ines >or Er#0 Mngemen( o> A!u#(s Ki( Is7uemic S(roeCircu#(ion1 ?@@ -ee


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Reinicir (er2i n(ii2er(ensi" siReinicir (er2i n(ii2er(ensi" si2cien(e es i2er(enso coe5is(en(e #uego2cien(e es i2er(enso coe5is(en(e #uego!e ? ors 0 2ermnece es(e!e ? ors 0 2ermnece es(e

neuro#ogicmen(e1 $II/ B*neuro#ogicmen(e1 $II/ B*

ECV ISUEMICOECV ISUEMICO RECOMENDACIONESRECOMENDACIONESAHAASA ?@@AHAASA ?@@

Hro#! e( #1 Gui!e#ines >or Er#0 Mngemen( o> A!u#(s Ki( Is7uemic S(roeCircu#(ion1 ?@@ -ee


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Mne'o !e HTA en ECV is7uFmicoMne'o !e HTA en ECV is7uFmico

Antes de TPAAntes de TPA: PAS )'.+ o PA ) ''$ 22!3PAS )'.+ o PA ) ''$ 22!3LABETALOLLABETALOL@?@mg EV ? minu(os/ re2e(ir5@?@mg EV ? minu(os/ re2e(ir5NICARDIPINONICARDIPINOin>usi,n/ mg/ (i(u#e ?/mg c! in>usi,n/ mg/ (i(u#e ?/mg c! min/ m5 mg1 Mn( mgmin/ m5 mg1 Mn( mg

esp,7s de TPAesp,7s de TPA: PAS '.$%&/$ o PA '$+%'&$ 22!3PAS '.$%&/$ o PA '$+%'&$ 22!3

LABETALOLLABETALOL@mg EV ? minu(os/ re2e(ir c@?@ min1@mg EV ? minu(os/ re2e(ir c@?@ min1

Dosis m5 @@mg1 O in>usion ?mgmin1Dosis m5 @@mg1 O in>usion ?mgmin1: PAS )&/$ o PA '&'%'($ 22!3PAS )&/$ o PA '&'%'($ 22!3

LABETALOLLABETALOLi!em oi!em oNICARDIPINONICARDIPINOi!emi!emNITROPRUSIATONITROPRUSIATO!e so!io!e so!io

Hro#! e( #1 Gui!e#ines >or Er#0 Mngemen( o> A!u#(s Ki( Is7uemic S(roe Circu#(ion1?@@-ee


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DIABETES MELLITUSDIABETES MELLITUS


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DIABETES MELLITUSDIABETES MELLITUSPROECCION AL ?@?PROECCION AL ?@?


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DIABETESDIABETES

Coe5is(enci HTADM DM?- @@Coe5is(enci HTADM DM?- @@(ienen HTA(ienen HTA3c(ores in!e2en!ien(es !e riesgo3c(ores in!e2en!ien(es !e riesgo

cr!io"scu#r1cr!io"scu#r1: Presi,n r(eri#Presi,n r(eri#: Micro#&uminuri1Micro#&uminuri1

Pre"enci,n !e 2rici,n !e DM en HTA1Pre"enci,n !e 2rici,n !e DM en HTA1Pre"enci,n !e e"en(os cr!io"scu#resPre"enci,n !e e"en(os cr!io"scu#resen DM1en DM1


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Riesgo !e Di&e(es !e no"o-Riesgo !e Di&e(es !e no"o-

com2r!o !iurF(icoscom2r!o !iurF(icos

S(essen e( #1 Be0on! B#oo! 2ressure1 Curr O2in Cr!io# ?@@ ??-1


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Por6enta8e de dia9etes de no:o;Por6enta8e de dia9etes de no:o;

BRABRA

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s(ergen1 Di&e(es Reserc n! C#inic# Prc(ice S1?@@1ss?

E3ECTOSE3ECTOS


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E3ECTOSE3ECTOSMETABOLICOSMETABOLICOS

E>ec(o $*-E>ec(o $*-&e(o7ue!ores 0&e(o7ue!ores 0!iurF(icos!iurF(icos ec(o neu(ro- CAA/- CAA/n(gonis(sn(gonis(s#!os(eron 0 #>#!os(eron 0 #>o7ue!ores1o7ue!ores1

E>ec(o $Q*-E>ec(o $Q*-Ini&i!oresIni&i!ores!e SRA1 Me'orn!e SRA1 Me'ornresis(enci insu#in1resis(enci insu#in1

No e5is(en es(u!ios !e im2c(oNo e5is(en es(u!ios !e im2c(o

c#Wnico so&re e>ec(os me(&,#icosc#Wnico so&re e>ec(os me(&,#icos!e BRA1 En cmino-!e BRA1 En cmino- VVIVALDI/IVALDI/INNOVAINNOVATTION/ ONION/ ONTTARGET/ARGET/TRATRASCEND1SCEND1

Tu+on1 E>ec(os 2#eio(ro2icos !e (e#misr(n en e# 2cien(e !i&F(ico1 Re" Es2 Cr!io#Su2#1?@@ -?A@A


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DIABETESDIABETES

PRESION OBJETIVOPRESION OBJETIVO

O&'e(i"o-O&'e(i"o- PA =@@mmHgPA =@@mmHg

$JNC / ESC*$JNC / ESC*

>


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Bene>icioBene>icio!e mne'o!e mne'o

!e PA en!e PA enDMDM

U6PDSU6PDSADVANCEADVANCE

C#mers1 J H02er(ens ? $su22# *-S?:S@1 ?@@


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ADVANCE TRIALADVANCE TRIAL

E# (r(mien(o n(ii2er(ensi"o conE# (r(mien(o n(ii2er(ensi"o con2erin!o2ri# in!m2mi!-2erin!o2ri# in!m2mi!-

Bene>icio !e !isminuci,n !e 2resi,n r(eri#Bene>icio !e !isminuci,n !e 2resi,n r(eri#=mmHg9 sW=mmHg9 sW

E5is(e &ene>icios en !i&F(icos i2er(ensos 0E5is(e &ene>icios en !i&F(icos i2er(ensos 0no i2er(ensos9 sWno i2er(ensos9 sW

Pro!uce &ene>icio !icion# en !i&F(icos 0Pro!uce &ene>icio !icion# en !i&F(icos 0(r(!os9 sW(r(!os9 sW


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MUERTE


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EN3ERMEDAD RENALEN3ERMEDAD RENAL


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XX


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HIPERTENSIXN EHIPERTENSIXN EINSU3ICIENCIA RENALINSU3ICIENCIA RENAL

!ipertensi-n arterial!ipertensi-n arterial

??YY cus !e en>erme!! ren# (ermin#1cus !e en>erme!! ren# (ermin#1

3c(or !e riesgo m4s im2or(n(e 2r3c(or !e riesgo m4s im2or(n(e 2r2rogresi,n !e IR12rogresi,n !e IR1

con IRC $=@m#min1m con IRC $=@m#min1m??* (ienen HTA1* (ienen HTA1

Cocro(> Gu#(Cocro(> Gu#(

DC $@e!!* $2eso* $cre(inin* $?*DC $@e!!* $2eso* $cre(inin* $?*

2or @1 si es mu'er2or @1 si es mu'er

Zou1 P0sio#ogic e"i!ence o> reno2r(o(ec(ion &0 n(i02er(ensi"e (er201 Curren( O2inionCr!io#og0 ?@@1 ?@-?@?

N > (WN > (W


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Ne>ro2(WNe>ro2(W!i&F(ic!i&F(ic

BRA en HTA 0 DM?BRA en HTA 0 DM?: ValsartanValsartanicio&ene>icio!icion# micro#&uminuri!icion# micro#&uminuri0 2rogresi,n en>erme!!-0 2rogresi,n en>erme!!-independiente2enteindependiente2ente!e#!e#ni"e# !e PA1ni"e# !e PA1

) MARVAL1 Vi&er(i1 Circu#(ion ?@@?@-?)) RENAAL1 Brenner1 NEJM ?@@-

Q LeKis1 NEJM ?@@ - @QQ DETAIL1 NEJM ?@@ -?


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IECA 0 BRAIECA 0 BRA: Disminu0en 2rogresi,n !e en>erme!! 0Disminu0en 2rogresi,n !e en>erme!! 0

2ro(erinuri12ro(erinuri1

: M0or &ene>icio en 2ro(einuri1M0or &ene>icio en 2ro(einuri1: Rmi2ri#Rmi2ri#- Su2erior me(ro2o#o# 0 m#o!i2ino1)- Su2erior me(ro2o#o# 0 m#o!i2ino1)

: Losr(n simi#r (rn!o#2ri#))1Losr(n simi#r (rn!o#2ri#))1

Ne>ro2(W NO !i&F(icNe>ro2(W NO !i&F(ic

)AAS61 A>ricn Americn S(u!0 o> 6i!ne0 Disese n! H02er(ension S(u!0 Grou21JAMA ?@@? ?- ???

))No1 COOPERATE1 Lnce( ?@@-?


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Recomen!ciones enRecomen!ciones enHTA 0 ne>ro2(WHTA 0 ne>ro2(W

PA o&'e(i"o =@@mmHgPA o&'e(i"o =@@mmHg)/)))/))/ PA menor si/ PA menor si2ro(einuri es ;g!W2ro(einuri es ;g!W))))

IECA 0 BRA son e#ecci,n1IECA 0 BRA son e#ecci,n1))))

Cui!!o con IECACui!!o con IECA))))))/ BRA si-/ BRA si-: Cre(inin- ;?/ $om&res* , ?mg!# $mu'eres*Cre(inin- ;?/ $om&res* , ?mg!# $mu'eres*

: Po(sio; mE71Po(sio; mE71

) JNC1 JAMA ?@@ ?- ?@??)) ESC ESH1 ?@@ Gui!e#ines >or (e mngemen( o> r(eri# 02er(ension1 Euro2enHer( Journ# ?@@1 ?/ ?

)))Rosen!or>>1 Tre(men( o> H02er(ension in Iscemic er( !isese1 Circ ?@@-??


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EN3ERMEDAD ARTERIALEN3ERMEDAD ARTERIALCORONARIACORONARIA

RIESGO DE EN3ERMEDAD CARDIOVASCULARRIESGO DE EN3ERMEDAD CARDIOVASCULAR


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RIESGO DE EN3ERMEDAD CARDIOVASCULARRIESGO DE EN3ERMEDAD CARDIOVASCULARCON SIN TRATAMIENTOCON SIN TRATAMIENTO

IECA CAA > ! ! i


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IECA "s CAA en en>erme!! coronriIECA "s CAA en en>erme!! coronri

[ECV- CCA su2erior IECA $&ene>icio 2@1@?*[Coronrios- IECA su2erior CAA $&ene>icio @ 2@1@?*

S(essen e( #1 Be0on! B#oo! 2ressure1 Curr O2in Cr!io# ?@@ ??-1

EN3ERMEDAD CORONARIAEN3ERMEDAD CEREBROVASCULAR

@

Hi2,(esis !e &ene>icio ini&i!ores !e# SRAHi2,(esis !e &ene>icio ini&i!ores !e# SRA


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Hi2,(esis !e &ene>icio ini&i!ores !e# SRAHi2,(esis !e &ene>icio ini&i!ores !e# SRA8Pro2orcion# riesgo cr!io"scu#r98Pro2orcion# riesgo cr!io"scu#r9

Asse#&ergs1 ACE ini&i(ion in cr!io"scu#r ris1 Curr O2in Cr!io# ?@@1??- ???


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R ! i HTA EAC


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Be(o7ue!ores !e cor( cci,n 0Be(o7ue!ores !e cor( cci,n 0cr!iose#ec(i"os $II/B*cr!iose#ec(i"os $II/B*Si con(rin!icci,n !e BBSi con(rin!icci,n !e BB- !i#(i.em o- !i#(i.em o

"er2mi#o $IB*"er2mi#o $IB*Hemo!inmicmen(e es(e- IECA $IA* oHemo!inmicmen(e es(e- IECA $IA* oBRA $IB* en IM n(erior/ HTA/ !is>unci,nBRA $IB* en IM n(erior/ HTA/ !is>unci,n

VI o DMVI o DMO&'e(i"oO&'e(i"o PA=@@ mmHgPA=@@ mmHg1 $IIB*1 $IIB*Cui!!o con PAD =@mmHg $IIB*Cui!!o con PAD =@mmHg $IIB*

Recomen!ciones 2r HTA 0 EACRecomen!ciones 2r HTA 0 EAC$$SCA STNESCA STNE* AHA ?@@* AHA ?@@

Rosen!or>>1 Tre(men( o> H02er(ension in Iscemic er( !isese1 Circ ?@@-??

R ! i HTA EACR ! i HTA EAC


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Recomen!ciones 2r HTA 0 EACRecomen!ciones 2r HTA 0 EAC$$SCA STESCA STE* AHA ?@@* AHA ?@@

Es(es emo!inEs(es emo!in- BB cr!iose#ec(i"o1 $II/B*- BB cr!iose#ec(i"o1 $II/B*HTA/ IM n(erior/ !is>unci,n !e VI o DMHTA/ IM n(erior/ !is>unci,n !e VI o DM- IECA- IECA$IA* o BRA $IB*1$IA* o BRA $IB*1Dis>unci,n !e VI 0 >## cr!WcDis>unci,n !e VI 0 >## cr!Wc- An(gonis(s- An(gonis(s!e #!os(eron/ !em4s e>ec(o n(ii2er(ensi"o!e #!os(eron/ !em4s e>ec(o n(ii2er(ensi"o!i(i"o1 $IA*1!i(i"o1 $IA*1Con(rin!ic!o BB/ in!ecu!o con(ro# !eCon(rin!ic!o BB/ in!ecu!o con(ro# !engin o PAngin o PA- CCA SR DHP1- CCA SR DHP1

Di#(i.em o "er2mi#o 2r TSPV $IIB*Di#(i.em o "er2mi#o 2r TSPV $IIB*O&'e(i"oO&'e(i"o PA=@@mmHgPA=@@mmHg/ cui!!o/ cui!!oPAD=@mmHg $Ii/ B*PAD=@mmHg $Ii/ B*


R ! i HTA EACR ! i HTA EAC


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Recomen!ciones 2r HTA 0 EACRecomen!ciones 2r HTA 0 EAC$$>## cr!Wc>## cr!Wc* AHA ?@@* AHA ?@@

Hi2er(ensi,n 0 so&recrg !e "o#umenHi2er(ensi,n 0 so&recrg !e "o#umen- Ti.i!s1- Ti.i!s1DiurF(icos ASA si >## ren#1 ICDiurF(icos ASA si >## ren#1 IC3## cr!Wc e HTA-3## cr!Wc e HTA-: IECA o BRA $cn!esr(n o "#sr(n* $IA*IECA o BRA $cn!esr(n o "#sr(n* $IA*

: BB $cr"e!i#o#/ &iso2ro#o# 0 me(ro2ro#o# succin(o*1BB $cr"e!i#o#/ &iso2ro#o# 0 me(ro2ro#o# succin(o*1: 3E=@- Es2irono#c(one o e2#erenone1 Pue!en ser us!os en3E=@- Es2irono#c(one o e2#erenone1 Pue!en ser us!os en

HTA re>rc(ri $IA*HTA re>rc(ri $IA*

A!icionr H0!r#.inISB !iurF(ico/ IECA o BRA 0 BBA!icionr H0!r#.inISB !iurF(ico/ IECA o BRA 0 BBen 2c(e negros C3 III o IV1 $I/B*en 2c(e negros C3 III o IV1 $I/B*

E"i(r CCA NoDHP $"er2mi#o/!(.*/ c#oni!in 0E"i(r CCA NoDHP $"er2mi#o/!(.*/ c#oni!in 0mo5oni!in1 $IIIB*mo5oni!in1 $IIIB*O&'e(i"oO&'e(i"o @@mmHg@@mmHg11



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HTA no con(ro#! Crisis Hi2er(ensi"


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Hi2er(ensi,n se"erUrgenci i2er(ensi"

Emergenci Hi2er(ensi"

PA $mmHg* ;@@ ;@@ Usu#men(e ;??@@

SWn(oms

Usu#men(esin(om4(ico

Ce>#e Ansie!!

Ce>#e in(ens Disne E!em

Angin

Disne DF>ici( neuro#,gico Trs(orno !e concienci Sngr!o

D+o ,rgnonco

No e"i!enci !e!+o gu!o ,rgno nco1

D+o #e"e ,rgno B#nco

SW/ !is>unci,n org4nic- 3## cr!Wc

!escom2ens!/ EAP

SCA Ence>#o2(i Insu>icienci ren# Preec#m2si 3## Ren# Aneurism

Mne'o gu!o

Inicir o

resumirme!icci,n Incremen(r

!osis si esin!ecu!

O&ser"r 2or ors

Disminuir PA con !rogs VOo 2ren(er#es1Am#o!i2ino ?/mg 0@ IECA O2(imi.r (r(mien(o

n(ii2er(ensi"o c(u#1 O&ser"ci,n 2or ors

An4#isis &s#es !e#&or(orio1

Tr(mien(o 2ren(er#1 Moni(oreo signos "i(#es

es(ric(o1

P#n E"#uci,n en ?ors E"#uci,n en ?? ors

Uni!! !e cui!!os crW(icos1 Disminuir "socons(ricci,n sinre!ucir er>usi,n1

Etiolo3>a Trata2iento


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Cor(ci,n !e or( ?,ir@r3i6o

Inter:en6ionis2o; ngio2#s(i con o sin s(en(

En>erme!! !e Cusing

?,ir@3i6o;Adene6to2ia transesfenoidal- Tr(mien(o cur(i"o !e e#ecci,n1Irradia6i-n pit,itaria o adrenale6to2ia 9ilateral1

Etirpa6i-n de adeno2as adrenales o t,2ores prod,6tores de ACT! e6t-pi6a 1

M7di6o; Espironola6tona y 6al6ioanta3onistas son e#(r(mien(o !e e#ecci,n 2re"io # (r(mien(o 7uir%rgico1

A#!os(eronismo

?,ir@r3i6o; Adrenele6to2ia en HTA se"er/ i2o#emi se"er/ #!os(eron sFric mu0 e#e"! 0 es(u!ios!e im4genes 2osi(i"os1

M7di6o; Mineralo6orti6oidesen 2cien(es no (ri&u(rios !e cirugW1 Consi!err e# uso !e es2irono#c(on ?

@@mg1

Hi2er(ensi,n reno"scu#r

?,ir@r3i6o- &02ss e# segmen(o es(eno(ico $or(oren#/ e2(oren#/ es2#enoren# o i#eoren#* o e5(ir2ci,n !e#ri+,n (r,>ico1Inter:ensionista- ngio2#s(i ren# (rns#uminr 2ercu(ne con s(en( $resu#(!os simi#res (r(mien(omF!ico*

M7di6o- en HTA !e >4ci# mne'o $usu#men(e re7uieren (er2i com&in!* sin !e(erioro !e >unci,n ren#1 IECA

o ARA II si no e5is(e es(enosis &i#(er# !e r(eris ren#es1 DiurF(icos 0o c#cion(gonis(s1

3eocromoci(om

?,ir@r3i6o; (r(mien(o !e e#ecci,n es e5(ir2ci,n !e# (umor secre(or !e c(eco#mins1Radioterapia y ,i2ioterapia- en neo2#si m#ign1M7di6o preoperatorioD- c#cion(gonis(s son (m&iFn e>ec(i"os1 E# me!icmen(o !e e#ecci,n son #oso7ue!ores !renergicos #>&e( $>eno5i&en.min)* !e&e ser inici!o @ !Ws n(es1

En>erme!!es (iroi!es

Mne'o !e # en>erme!! en!ocrin 2ue!e norm#i.r #s ci>rs !e 2resi\n r(eri#1

Be(o7ue!ores en i2er2ro(iroi!ismo1


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Recomen!cionesRecomen!cionesESC ?@@ESC ?@@

en csos es2eci#esen csos es2eci#es


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CONCLUSIONESCONCLUSIONES

E# ni"e# !e 2resi,n r(eri# es # ##"e !e mne'oE# ni"e# !e 2resi,n r(eri# es # ##"e !e mne'oHTA en es2eci# ECV1HTA en es2eci# ECV1E# e>ec(o 2#eio(ro2ico !e ini&i!ores !e# SRA esE# e>ec(o 2#eio(ro2ico !e ini&i!ores !e# SRA es&ene>icioso en #guns circuns(ncis- En>1&ene>icioso en #guns circuns(ncis- En>1

Ren#/ en> Coronri/ >## cr!Wc1 A#(o riesgo1Ren#/ en> Coronri/ >## cr!Wc1 A#(o riesgo1A!em4s !e# (r(mien(o n(ii2er(ensi"o seA!em4s !e# (r(mien(o n(ii2er(ensi"o se!e&erW mne'r o(ros 3RC en es2eci# en!e&erW mne'r o(ros 3RC en es2eci# en2cien(es !e #(o riesgo12cien(es !e #(o riesgo1

E# (r(mien(o !e 2resi,n norm# #( 2o!rW serE# (r(mien(o !e 2resi,n norm# #( 2o!rW ser&ene>icioso 2r e"i(r e# !esrro##o !e&ene>icioso 2r e"i(r e# !esrro##o !ei2er(ensi,n se"er 0 !+o ,rgno nco1i2er(ensi,n se"er 0 !+o ,rgno nco1

hta en grupos especiales

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