HIPERTENSIN

ARTERIAL

Oswaldo Leandro Nina

Cueva
2010 - 10540

DEFINICIN
sustained elevation of systemicarterialblood pressure,most
commonly definedas systolic blood pressure (SBP) 140 mm
Hg or diastolic blood pressure (DBP) 90 mm Hg

DIAGNOSTICO
Diagnosis ofhypertensionshould be based on 2 blood pressure
measurements per visit on 2 visits (ESH/ESC Class I, Level C)(4)

DEFINICIN Y
CLASIFICACIN

CRISIS HIPERTENSIVAS
Las crisis hipertensivas se definen como una elevacin aguda de la
presin arterial capaz de llegar a producir alteraciones
estructurales o funcionales en diferentes rganos.
Crisis hipertnsiva: Pacientes con PAS> 179 PAD> 109 mmHg.
JNC 7.

ESTRATIFICACIN DE
RIESGO

TOMA DE LA PRESIN
ARTERIAL EN CONSULTA

DX DIFERENCIALES

DX DIFERENCIALES

TRATAMIENTO

NICE
El diagnstico de HTA primaria o esencial debe ser confirmado
con MAPA o AMPA como gold standard

NICE

Antes de asociar una segunda

droga, debe aumentarse la dosis
de la primera.

NICE OBJETIVOS DE LA P.A.

En consulta:
< 80 aos: < 140/90
> 80 aos: < 150/90

Media de la MAPA o
AMPA:
< 80 aos: < 135/85
> 80 aos: < 145/85

El objetivo de TA cercano a 130 y a 80

HTA aislada (TA objetivo < 140/90):
Frmacos 1 lnea: todos excepto a-bloq, BB (> 60 aos)
Monoterapia > Combinacin
Diabetes Mellitus (TA objetivo < 130/80):
iECAS o ARA II
iECAS o ARA II + CalAnt

ESH/ESC GUIDELINES

ESH/ESC GUIDELINES INDIVIDUALIZACIN

ESH/ESC GUIDELINES INDIVIDUALIZACIN

ESH/ESC GUIDELINES CONVINACIONES

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).

JAMA RECOMENDACIONES
In general black population, including those with
diabetes:
Initial antihypertensive treatment should include :

Thiazide-type diuretic
CCB.

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.

JAMA RECOMENDACIONES

EN RESUMEN:
No Raza Negra / <55aos / ERC / DM /
Coronary artery diseases

De Raza Negra / >55aos

IECA:

CCB:

Captopril: 25 150 mg/d, dividido en 3

dosis
Enalapril: 2.5 40 mg/d, dividido en 2
dosis

Amlodipino: 2.5 1 mg/d

Nifedipino: 20mg/12h
Verapamilo: 120 360 mg/d

Thiazidas:

Hidroclorotiazida: 12.5 50 mg/d

ARA-II:

Irbersartan: 150 300 mg/d

Losartan: 25 100 mg/d, 1 dosis o 2
dosis
Valsaltran: 80 32 mg/d

EN RESUMEN:
Hipertensin 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-bloquers
CCB

EN RESUMEN:
Aspirin
low-dose aspirin suggested in patients withhypertensionat
high risk for cardiovascular disease
for primary prevention of cardiovascular disease in patients
withhypertension, aspirin reduces myocardial infarction,
increases bleeding, and does not reduce strokes or total
cardiovascular events

EN RESUMEN:
considerstatinsfor patients
cardiovascular disease

at

increased

risk

for

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