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DEFINICIN

HIPERTENSIN ARTERIAL
SISTMICA
ENFERMEDAD
Multifactor
Controlabl
Crnica
ial
e
caracterizada por aumento
SOSTENIDO de
Presin arterial
Presin arterial sistlica
diastlica (PD)
(PS) por arriba de 140 y/o
igual o mayor a 90
mmHg
mmHg.
James PA, Oparil S, Carter BL, et al. 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).

HIPERTENSIN ARTERIAL
TRASCENDENCIA

ID PRE
EN CU
CO TIFIC RSO
RR AB R
EG LE
IB L
E Y

HIP
ERT
E
AR
TER NSIO
IAL N

EN
C A FE
RD RM
IO ED
V
AR AS AD
CU
L

HIPERTENSIN ARTERIAL
TRASCENDENCIA

HIPERTENSIN ARTERIAL
EPIDEMIOLOGA

PREVALENCIA:
1373 de cada 100000
3187665 son
prehipertensos
717529 hipertenso

>

>

EDAD DE
PRESENTACIN

ENSANUT 2013

HIPERTENSIN ARTERIAL
EPIDEMIOLOGA

ENSANUT 2013

PRESIN

Ley de
LAPLACE YOUNG
NO

T
P

Es lo
mismo
que
TENSIN
ARTERIAL
?

T
PRESIN Y TENSIN SON
VARIABLES DIRECTAMENTE
PROPORCIONALES pero NO
son lo mismo.
Si la PRESIN AUMENTE
entonces LA TENSIN
AUMENTA
Si el RADIO del vaso
AUMENTE entonces LA
TENSIN AUMENTA

RECORDAR LOS
ANEURISMAS

Principio de
PASCAL

Magnitud fsica que mide


la fuerza por unidad de
superficie
Fuerza ejercida por la sangre en una
superficie determinada de la pared
interna (endotelio) del vasos
sanguneo por el que circula dicha
sangre.
Presin
cuantificam
ABSOLUTA
os
Es la presin
Presin
manomtrica
RELATIVA
MS la
(MANOMTRI
presin
CA)
atmosfrica

DETERMINADA POR FACTORES


MODIFICAB
NO
Estilo de
LES
MODIFICABLES
vida
Carga gentica
Alimentaci
Edad
n
Raza (etnia)
Actividad
Fsica
Tabaquismo
Alcoholismo
Estrs
emocional
TCNICA

MTODOS
Directo

Indirecto

INVASIVO

NO
INVASIVO

Mediante
catter
intravascu
lar

Mediante
un
esfigmomanmetr
o

PALPO
AUSCULTATORIA
Principio
Nmero
de
de
BERNOUL
REYNOLD
LI
S

CLASIFICACIONES

ESH
MENOS

MAS
Utilizado

JNC-VIII

HIPERTENSIN ARTERIAL
FISOPATOLOGA

Fauci AS , Kasper DL, Branwald E. Harrison Principios de Medicina Interna, 17a edicin Capitulo

FISIOPATOLOGA
PERFUSI
N RENAL

Hgad
o

Ri
n

Angiotensinge
no
ANGIOTENSIN
Pulm
A
Angiotensina n
II

RENIN
A

PRESIN
ARTERIAL

PRESIN
ARTERIAL

Resistencia
vascular
Volumen
extracelular

Clulas
endoteliale
s

EC
A

Receptores
AT
Msculo
Capa glomerular
liso
GLNDULA
vascular
SUPRARRENAL

VASOCONSTRICCI
N
H2 0

ALDOSTERON
A
Nefrona
Reabsorcin de
Na

HIPERTENSIN ARTERIAL
CLASIFICACIN

ETIOLOGA
HIPERTENS
IN
ARTERIAL
SISTMICA

ESENCIAL O
PRIMARIA
SECUNDARI
A

90-95%
5-10%

ESTABLE

CRISIS
HIPERTENSI
VA

URGENCIA
HIPERTENSIVA
EMERGENCIA
HIPERTENSIVA

Jimnez L, 2004; Aparicio M, 2005; De Castro S, 2007; Llabrs J, 2007

HIPERTENSIN ARTERIAL
CLASIFICACIN
CLASIFICACI
N

PAS
(mmHg)

PAD
(mmHg)

NORMAL

< 120

< 80

120-139

80-89

140-159

90-99

> 160

> 100

> 150

> 90

PREHIPERTEN
SIN
HAS ESTADIO
1
HAS ESTADIO
2
HIPERTENSIN
ARTERIAL

James PA, Oparil S, Carter BL, et al. 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).

CLASIFICACIN
ENFERMEDAD HIPERTENSIVA ASOCIADA
AL EMBARAZO

Fauci AS , Kasper DL, Branwald E. Harrison Principios de Medicina Interna, 17a edicin Capitulo

HIPERTENSIN ARTERIAL
VALORACIN

Exploracin Fsica
Presin de miembros
Pulso
Decbito dorsal
Posicin de Pie 2 min
PD decbito dorsal
HAP

HAS

Prim C
NOM-030-SSA2-2009

Exploracin Fsica
Auscultar Cartidas
Cardipulmonar
Hipertrofia de
ventrculo izquierdo
Desplazamiento
del choque punta
Tercero y cuarto
ruido
Estertores
crepitantes

Abdominal
Soplos
Diastlicos
continuos
A la derecha o
izquierda lnea
media

Prim C

Tratamiento
Tratamiento

James PA, Oparil S, Carter BL, et al. 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).

James PA, Oparil S, Carter BL, et al. 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).

TRATAMIENTO
FARMACOLGICO
ABORDAJE

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #1

INICIO DEL
TRATAMEINTO

En la poblacion general de 60
aos o ms, inicie el tratamiento
farmacologico para reducir la
presion arterial:
150 mmHg
con
una presion arterial sistolica
mmHg
(PAS) ______ 90
mmH
, o con una
presion arterial diastolica (PAD)
______ mmH
James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #1

META DEL
TRATAMEINTO

En la poblacion general de 60
aos
o
ms,
se
brinda
mmHg
tratamiento 150
hasta
una meta de
PAS menor de90______
mmHgmmHg y una
meta de PAD menor de ______
mmH

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #1

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #2

INICIO DEL TRATAMEINTO


PAD 90 mmHg
James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #3

INICIO DEL TRATAMEINTO


PAS 140 mmHg
James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #4

1
18 a 70 aos de
edad con CrCl
60 mL/min/1.73m2

INICIO
PAS 140
mmHg

META
PAS 140
mmHg

INICIO
2
Cualquier edad con
albuminuria sin
importar su CrCl

PAD 90
mmHg

META
PAD 90
mmHg

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #4

RECUERDA: La hipertensin arterial sistmica y la proteinuria destacan


como los mayores predictores de progresin y, a su vez, factores de riesgo
modificables de la enfermedad renal crnica (ERC).
Medicina & Laboratorio, Volumen 13, nmeros 7-8, 2007

JNC-8
RECOMENDACION #4

Microalbumiruia

4% de la
poblacin sana

30% de los
pacientes
hipertensos

Medicina & Laboratorio, Volumen 13, nmeros 7-8, 2007

JNC-8
RECOMENDACION #4

-: menos de 10
mg/dL
+: 30 mg/dL
++: 100 mg/dL
+++: 300 a 1.000
mg/dL

Medicina & Laboratorio, Volumen 13, nmeros 7-8, 2007

JNC-8
RECOMENDACION #4

Proteinuria
(> 3 g/ 24 horas)

Meta mas baja


(<130/80 mm Hg)

Beneficio en
terminos
de los eventos
renales solamente.

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #5

HAS + DM
PAS 130 mmHg

INICIO
PAS 140
mmHg

META
PAS 140
mmHg

INICIO
PAD 90
mmHg

META
PAD 90
mmHg
James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #6
Si se excluye a los afroamericanos, en la poblacion general,
incluyendo a los diabeticos, el tratamiento inicial debe incluir
uno de los siguientes frmacos:

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #6
Las 4 clases de frmacos recomendados tienen efectos comparables
sobre la mortalidad global y los eventos cardiovasculares,
cerebrovasculares y renales

EFECTIVIDAD

MEJORA EN
FALLA
CARDIACA

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #6
NO se recomiendan como frmacos de primeral lnea

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #6
NO se recomiendan como frmacos de primeral lnea

JNC-8
RECOMENDACION #7
En la poblacion de pacientes
afroamericanos el tratamiento
antihipertensivo inicial debe incluir un
bloqueador de los canales de calcio
o
diuretico tipo tiazida

SIN diabetes

CON diabetes

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #7

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #8

En la poblacion de 18 anos o mas con


enfermedad renal cronica e hipertension,
el tratamiento antihipertensivo inicial (o
agregado) debe incluir un IECA o un
ARA
para
mejorar
los
eventos
renales.

Esto se aplica a todos los pacientes con


enfermedad renal cronica e hipertension,
independientemente del grupo etnico
o de la presencia de diabetes
James PA, Oparil S, Carter BL, et al. 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).

JNC-8
RECOMENDACION #9
El principal objetivo del tratamiento es
alcanzar y mantener la presion
arterial meta.
Si esta no se alcanza en un mes de
tratamiento, aumente la dosis de la
droga inicial o agregue una segunda
droga de las clases mencionadas en la
recomendacion 6.
El medico debe continuar ajustando el
tratamiento hasta que se alcanza la
presion arterial meta. Si esta no se
alcanza aun, agregue y titule una
tercera droga de la lista.

James PA, Oparil S, Carter BL, et al. Evidence based-guideline for the management of high
blood pressure in adults: Report from the panel members appointed to the Eighth Joint National
No use un IECA y un Committee
(JNC 8).
ARA juntos.

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
SELECCIN DEL
FRMACO

James PA, Oparil S, Carter BL, et al. 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).

James PA, Oparil S, Carter BL, et al. 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).

James PA, Oparil S, Carter BL, et al. 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).

JNC-8
SELECCIN DEL
FRMACO

Nifedipino
Amlodipino

Diltiazem
Verapamil

Color Atlas of Physiology, Agamemnon Despopoulos, Stefan Silbernagl, 1991, New York

JNC-8
INICIO DEL FRMACO

James PA, Oparil S, Carter BL, et al. 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).

James PA, Oparil S, Carter BL, et al. 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).

James PA, Oparil S, Carter BL, et al. 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).