1. HIPERTENSION ARTERIAL
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2. CONCEPTO
• La Presión Arterial (PA) se define
como la fuerza ejercida por la
sangre contra cualquier área de la
pared arterial y se expresa a través
de las diferentes técnicas de
medición como PA sistólica, PA
diastólica y PA media.
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3. Cont...
• Controlada por el Gasto cardiaco y Resistencia vascular
periferica. (GC), (RVP).
• GC: Determinado por la frecuencia cardiaca y la fuerza
de contracción.
• RVP: Dependerá de la actividad constrictora o dilatadora
de las arteriolas, del eje renina angiotensina y de la
propia magnitud del GC.
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4. EPIDEMIOLOGIA.
• La hipertensión arterial afecta a 50 millones de personas
en EEUU, y 1 Billón en todo el mundo.
• Es el diagnostico primario mas frecuente en América 35
millones de consultas como dx primario.
• Los objetivos de salud poblacional para el 2010 están por
debajo del 50% del ideal.
• Aproximadamente el 30% de la población desconoce ser
Hipertenso.
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5. CONOCIMIENTO DE LA
PATOLOGIA
10
29 27
34
2
16
0
10
20
30
40
50
60
70
80
1976-80 1988-91 1991-94 1999-2000
Conocida
Tratada
Controlada
Control España
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6. PREVALENCIA HTA
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45
64.4
71.7 70.8
0
20
40
60
80
* Banegas JR, et al. Hypertension 1998; 32: 998-1002 (datos de 35-64 años)
† Banegas JR, et al. Hypertension 2002; 20: 2157-64 (datos en > 60 años)
35-64 60-69 70-79 >79
16.3
32.2
82.3
0
10
20
30
40
50
60
70
80
90
Control global Control PAS Control PAD

7. FACTORES DE RIESGO CV.
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8. CLASIFICACION
• ETIOLOGIA
• SEGÚN RENINA.
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•CLINICA (TA)

9. ETIOLOGIA
• IDIOPATICA (PRIMARIA)
• SECUNDARIA
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10. SECUNDARIA
Renales
• Enfermedad del Parénquima
• Nefritis crónica.
• Enfermedad poliquística.
• Enfermedad del colágeno vascular.
• Nefropatía diabética.
• Hidronefrosis.
• Glomerulonefritis aguda.
Renovascular
• Cualquier lesión que obstruya las arterias renales, tanto grandes;
como chiquitas.
• Estenosis renal.
• Infarto renal y otros
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11. Endocrinas
• Suprarrenales
• Feocromocitoma.
• Aldosteronismo primario.
• -Producción excesiva de: DOC y 18OH-DOC y otros mineralocorticoides.
• Hiperplasia suprarrenal congénita
• Síndrome de Cushing por tumoración suprarrenal, por tumores hipofisarios.
• Tumores cromafines extrasuprarrenales.
Hiperparatiroidismo.
Acromegalia.
HT por embarazo.
Coartación de la aorta.
Trastornos neurológicos.
• HT intracraneana.
• Cuadriplejía.
• Envenenamiento por plomo.
• Síndrome de Guillain-Barré.
• 6.- Post-operatorio.
Fármacos y sustancias químicas.
• Ciclosporina.
• Anticonceptivos orales.
• Glucocorticoides.
• Mineralocorticoides.
• Simpaticomiméticos.
• Tiramina e inhibidores de la MAO.
Tóxicas
• Plomo.
• Talio.
• Mercurio.
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12. SEGÚN NIVEL DE RENINA
• Renina alta: 10% de los pacientes hay
resistencias vasculares aumentadas.
• Renina Normal: 60% de los pacientes
asociada a volumen dependiente + aumento de
resistencias.
• Renina Baja: 30% de los pacientes se
asocian con ser volumen dependientes.
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13. CLASIFICACION SEGÚN TA
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14. BENEFICIOS DEL
CONTROL DE LA TA
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15. HIPERTENSION SISTOLICA.
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18. IDEAS CLAVES JNC7
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• Para pacientes >50 a es mas importante como RCV la
presión sistólica que la diastolica.
• El RCV se duplica por 20/10mmHg por encima de 115/75.
• Los pacientes > 55a tienen 90% probabilidades de HTA
• Las personas con TA 120-39/80-89 se consideran
prehipertensos y hay que modificar su LS.
Chobanian AV et al JAMA 2003; 289:2560-72

19. Cont…
• La hidroclorotiazida debería ser usado en la mayoría de
pacientes con HTA no complicada.
• La mayoría de ptes requerirá 2 o mas antihipertensivos
para obtener el nivel ideal <140/90, <130/80 en DM, IRC
• Si la presión arterial es 20/10 arriba del objetivo debería
iniciarse con 2 antihipertensivos, y uno de ellos seria una
tiazida.
• La efectividad del tratamiento depende de la motivación.
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Chobanian AV et al JAMA 2003; 289:2560-72

20. MODIFICACION ESTILO DE
VIDA
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21. RECOMENDACIONES
• Utilizar método auscultatorio, aparato calibrado
adecuadamente.
• Paciente debe estar sentado en silla por 5 minutos, pies
en el suelo brazo a altura corazón.
• Tamaño adecuado del brazalete (>80% el brazo).
• Dar por escrito la TA, y concientizar en objetivos.
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22. AUTOMEDIDA PA
• Proporciona informacion del control del
paciente.
• Evita la HTA bata blanca.
• Niveles > 135/85mmHg son tomados
como hipertensos.
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23. M.A.P.A
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26. EXAMENES VALORACION
INICIAL HTA.
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28. ANTIHIPERTENSIVO DE
ELECCION SEGÚN
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29. COMBINACIONES DE
ANTIHIPERTENSIVOS
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30. ANTIHTA Y HVI
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31. IECA Y DAÑO RENAL
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33. CONSIDERACIONES
ESPECIALES
• SX METABOLICO X: Modificar estilo de vida,
antihipertensivos.
• HVI: Modificar estilo de vida, antihipertensivos excepto
vasodilatadores directos (hidralacina, minoxidil)
• EAP( Enfermedad arterial periferica): usar ASA +
antihipertensivos.
• HTA ancianos: iniciar con diureticos tiazidicos o la
combinacion de tiazida mas BB, BCC, ARAII, IECA,
ALDOMET.
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34. • Hipotension postural: Valorar este efecto en
ancianos que usan sildenafil,diureticos, tomar TA de pie
un descenso de TAS >10mmHG
• En Mujeres: Evitar ACO, en caso de embarazo: se
recomiendan alfametildopa, BB, vasodialtadores,
evitar IECA Y ARAII.
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40. FARMACOS
ENDOVENOSOS EN
EMERGENCIAS U.S. Department of
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41. EFECTOS ADVERSOS
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43. ELECCION DE FARMACO
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44. U.S. Department of
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ANTIHIPERTENSIVOS
ORALES EN URGENCIAS