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JNC 8
¿Qué hay de nuevo?
Dr. Edgar F. Hernández Paz, M.A.G.C., F.A.C.C.
Cardiólogo
Caso Clínico
Un paciente masculino de 66 años, sin antecedentes
médicos de importancia, es encontrado hipertenso en
varias...
Caso Clínico
¿Cómo tratar?
Caso Clínico
a. Continuar con cambios en el estilo de vida
b. Iniciar medicamento antihipertensivo
¿Cómo tratar?
WHO World Health Report 2004
CV diseases
Cancer
Infectious and
parasitic diseases
Other non-infectious
diseases
Injuries
R...
El Riesgo de Mortalidad CV se Duplica con Cada
Incremento de 20/10 mmHg en la PA
PA= presión arterial
*Individuos comprend...
Prevalencia de Factores de Riesgo Cardiovascular
América Latina
Lamas et al. Circulation. 2007; 115 (9): 1067.
JNC 4
Md Med J. 1988 Sep;37(9):698-701
JNC 5
Arch Intern Med. 1993;153:154-183
JNC 6
Arch Intern Med. 1997 Nov 24;157(21):2413-46
JNC 7
JAMA 2003 May 21;289(19):2560-72
JAMA 2014; 311(5):507-20
El JNC 8 no incluye guías de
diagnóstico ni de clasificación de la
hipertensión
Se revisaron estudios entre 1966 y 2009 que
llenaron ciertos criterios
9 recomendaciones principales y una corolaria
5 bas...
– Recomendación fuerte (grado A)
Recomendación 1:
< 150/90 en pacientes de 60 años o más
– Opinión de expertos (grado E)
Recomendación corolaria:
No hay necesidad de reducir dosis de
medicamentos si la PA es men...
– Recomendación fuerte (grado A) en edades de
30 a 59 años, opinión de expertos (grado E) de 18
a 29 años
Recomendación 2:...
– Opinión de expertos (grado E)
Recomendación 3:
Sistólica < 140 en pacientes menores de
60 años
– Opinión de expertos (grado E)
Recomendación 4:
< 140/90 en enfermedad renal crónica
– Opinión de expertos (grado E)
Recomendación 5:
< 140/90 en diabéticos
– Recomendación moderada (grado B)
Recomendación 6:
En pacientes de raza no negra, iniciar
con un diurético tiazídico, un ...
– Recomendación moderada (grado B) para la
población negra en general, débil (grado C) si
diabéticos
Recomendación 7:
En p...
– Recomendación moderada (grado B)
Recomendación 8:
IECAs o BRAs en enfermedad renal
crónica
– Opinión de expertos (grado E)
Recomendación 9:
Si no se llega a la meta, aumentar
Si no se ha llegado a la meta con una
droga, aumentar dosis o agregar un segundo
medicamento (IECA, BRA, calcio-antagonist...
Thomas G, et al. Cleveland Clinic Journal of Medicine 2014;81(3):178-
188
BRAs vs. IECAs - ONTARGET
ONTARGET Investigators. NEJM 2008. 358:1547-1559.
Tamargo J, et al. Rev Esp Cardiol Supl. 2006;6:10C-24C
ACCOMPLI
SH
Jamerson K, et al. NEJM
2008; 359: 2417-28
©2008 UpToDate®
Beta-
bloqueadores:
Estudio LIFE
JAMA 2014; 311(5):507-20
Terapia no farmacológica
JAMA 2014; 311(5):507-20
¿Y qué dicen los
europeos?
Journal of Hypertension 2013;157(31):1281-
1357
Guías ESH/ESC 2013
Journal of Hypertension 2013;157(31):1281-
1357
Guías ESH/ESC 2013
¡GRACIAS!
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JNC 8: ¿Qué hay de nuevo?

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Las nuevas guías americanas para el tratamiento de la hipertensión arterial.

Published in: Health & Medicine
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JNC 8: ¿Qué hay de nuevo?

  1. 1. JNC 8 ¿Qué hay de nuevo? Dr. Edgar F. Hernández Paz, M.A.G.C., F.A.C.C. Cardiólogo
  2. 2. Caso Clínico Un paciente masculino de 66 años, sin antecedentes médicos de importancia, es encontrado hipertenso en varias visitas a la oficina, habiendo ya iniciado cambios en el estilo de vida Cifras de PA: Visita 1: 146/86 mmHg Visita 2: 149/85 mmHg Visita 3: 144/88 mmHg
  3. 3. Caso Clínico ¿Cómo tratar?
  4. 4. Caso Clínico a. Continuar con cambios en el estilo de vida b. Iniciar medicamento antihipertensivo ¿Cómo tratar?
  5. 5. WHO World Health Report 2004 CV diseases Cancer Infectious and parasitic diseases Other non-infectious diseases Injuries Respiratory diseases Respiratory infections Maternal and perinatal conditions Nutritional deficiencies Cardiovascular diseases leading causes of global mortality
  6. 6. El Riesgo de Mortalidad CV se Duplica con Cada Incremento de 20/10 mmHg en la PA PA= presión arterial *Individuos comprendidos entre 40-69 años de edad (N=1 millón). Lewington S et al. Lancet. 2002;60:1903-1913.
  7. 7. Prevalencia de Factores de Riesgo Cardiovascular América Latina Lamas et al. Circulation. 2007; 115 (9): 1067.
  8. 8. JNC 4 Md Med J. 1988 Sep;37(9):698-701
  9. 9. JNC 5 Arch Intern Med. 1993;153:154-183
  10. 10. JNC 6 Arch Intern Med. 1997 Nov 24;157(21):2413-46
  11. 11. JNC 7 JAMA 2003 May 21;289(19):2560-72
  12. 12. JAMA 2014; 311(5):507-20 El JNC 8 no incluye guías de diagnóstico ni de clasificación de la hipertensión
  13. 13. Se revisaron estudios entre 1966 y 2009 que llenaron ciertos criterios 9 recomendaciones principales y una corolaria 5 basadas en opinión de expertos 2 “moderadas” 1 “débil” 2 “fuertes” (evidencia de alta calidad)
  14. 14. – Recomendación fuerte (grado A) Recomendación 1: < 150/90 en pacientes de 60 años o más
  15. 15. – Opinión de expertos (grado E) Recomendación corolaria: No hay necesidad de reducir dosis de medicamentos si la PA es menor de 140
  16. 16. – Recomendación fuerte (grado A) en edades de 30 a 59 años, opinión de expertos (grado E) de 18 a 29 años Recomendación 2: Diastólica < 90 en pacientes menores de 60 años
  17. 17. – Opinión de expertos (grado E) Recomendación 3: Sistólica < 140 en pacientes menores de 60 años
  18. 18. – Opinión de expertos (grado E) Recomendación 4: < 140/90 en enfermedad renal crónica
  19. 19. – Opinión de expertos (grado E) Recomendación 5: < 140/90 en diabéticos
  20. 20. – Recomendación moderada (grado B) Recomendación 6: En pacientes de raza no negra, iniciar con un diurético tiazídico, un calcio- antagonista, un IECA o un BRA
  21. 21. – Recomendación moderada (grado B) para la población negra en general, débil (grado C) si diabéticos Recomendación 7: En pacientes de raza negra, iniciar con un diurético tiazídico, o un calcio- antagonista
  22. 22. – Recomendación moderada (grado B) Recomendación 8: IECAs o BRAs en enfermedad renal crónica
  23. 23. – Opinión de expertos (grado E) Recomendación 9: Si no se llega a la meta, aumentar
  24. 24. Si no se ha llegado a la meta con una droga, aumentar dosis o agregar un segundo medicamento (IECA, BRA, calcio-antagonista o tiazídico) Si aún no se alcanza la meta, agregar tercera droga NO combinar nunca IECA y BRA Si hay contraindicaciones para alguna droga, o si se necesitan más de 3 medicamentos, recurrir a otras clases
  25. 25. Thomas G, et al. Cleveland Clinic Journal of Medicine 2014;81(3):178- 188
  26. 26. BRAs vs. IECAs - ONTARGET ONTARGET Investigators. NEJM 2008. 358:1547-1559.
  27. 27. Tamargo J, et al. Rev Esp Cardiol Supl. 2006;6:10C-24C
  28. 28. ACCOMPLI SH Jamerson K, et al. NEJM 2008; 359: 2417-28
  29. 29. ©2008 UpToDate® Beta- bloqueadores: Estudio LIFE
  30. 30. JAMA 2014; 311(5):507-20
  31. 31. Terapia no farmacológica JAMA 2014; 311(5):507-20
  32. 32. ¿Y qué dicen los europeos?
  33. 33. Journal of Hypertension 2013;157(31):1281- 1357 Guías ESH/ESC 2013
  34. 34. Journal of Hypertension 2013;157(31):1281- 1357 Guías ESH/ESC 2013
  35. 35. ¡GRACIAS!

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