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Fisiopatologia de la hipertension arterial

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  • DOWNLOAD THAT BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download Full doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download PDF EBOOK here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download EPUB Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... Download doc Ebook here { http://bit.ly/2m6jJ5M } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book that can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer that is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story That Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths that Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
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Fisiopatologia de la hipertension arterial

  1. 1. UNIVERSIDAD DE LA SABANA FACULTAD DE MEDICINADEPARTAMENTO DE FARMACOLOGIA CLINICAESPECIALIZACION EN FARMACOLOGIA CLINICA PATOGENESIS DE LA HIPERTTENSION Dr. LUIS RAFAEL MARTINEZ CUADRO RESIDENTE DE FARMACOLOGIA CLINICA 2013
  2. 2. OBJETIVOS• Conocer los diferentes factores, la influencia del estilo de vida y hábitos alimenticios en la incidencia de la HTA y riesgo cardiovascular.• Conocer los diferentes componentes en la fisiopatologia de la HTA y su implicacion clinicoterapeutica.• Saber que la HTA primaria o idiopatica tiene causas moleculares.
  3. 3. HIPERTENSION ARTERIAL• PA: RPT x VMC• En el 2025 aprox 1.56 mil millones estaran afectadas.• Factor de riesgo importante para la enfermedad cardiovascular y es responsable de la mayoría de las muertes en el mundo.• La hipertensión primaria, conocida como hipertensión esencial o idiopática, representa hasta el 95% de todos los casos de HTA.
  4. 4. FACTORES DE RIESGOS
  5. 5. SODIO EN LA DIETA E HTA Dieta con Na+ < 50 mmol/día ausencia de HTA Dieta por encima de 100 mmol/día HTA METAANALISIS EN ENSAYOS CLINICOS CONTROLADOS Na+ 50 mmol/dia HIPERTENSOS: NORMOTENSOS: • PAS 4 mmHg • PAS 2 mmHg • PAD 2,5 mmHg • PAD 1 mmHg
  6. 6. Dietas ricas en el contenido de potasio y sodioEn comparación con las dietas basadas en alimentos naturales, las dietas basadas en alimentos procesados ​son altos en sodio y baja en potasio (57 g) contiene una naranja (131 g) 32 mmol de sodio y No contiene sodio 4 mmol de potasio 6,0 mmol de potasio
  7. 7. EFECTOS VASCULARES EN LA DEPLECION DE POTASIO K+ EFECTO PRESOR BOMBA DE ACTIVACION DE LA CELL PARA LAN+/K+ ATP asa OBTENCION DE Na+ RETENCION DE Na+ Na+
  8. 8. Efectos cardiovasculares de la suplementación de potasio• Ingesta de K+ es inversa/ proporcional a la PA• Si baja la excreción de K+ la PAS.• Dieta rica en K+ tiene efecto cardioprotector y disminuye la necesidad de antihipertensivo (estudio DASH)• La sensibilidad al Na+/. PTE HTA:  Baja ingesta de K+ PAS 7 mmHg PAD 6 mmHg (10-16 mm/dia) RETENCION DE  Ingesta habitual de Na+ Na+, PA NORMOTENSOS: PAS 6 mmHm (120-200 mmol/dia) PAD 4 mmHg
  9. 9. La falta de adaptación de los riñones a la dieta moderna N engl j med 356;19 www.nejm.org may 10, 2007 The New England Journal of Medicine
  10. 10. Mecanismos de sodio alterado y la homeostasis del potasio Se reabsorve el Na filtrado N engl j med 356;19 www.nejm.org may 10, 2007 The New England Journal of Medicine
  11. 11. N engl j med 356;19 www.nejm.org may 10, 2007 The New England Journal of Medicine
  12. 12. Retención de sodio, pérdida de potasio en la hipertensión arterialROSTAFUROXINA MAR 0400 N engl j med 356;19 www.nejm.org may 10, 2007 The New England Journal of Medicine
  13. 13. La homeostasis del sodio y el potasio La retención de sodioNiveles de Dimetil L-Arginina síntesis de NO
  14. 14. Via molecular de la vasodilatación inducida por el potasio N engl j med 356;19 www.nejm.org may 10, 2007 The New England Journal of Medicine
  15. 15. Vías moleculares implicados en los efectos centrales de sodio y de potasio sobre la presión arterial N engl j med 356;19 www.nejm.org may 10, 2007 The New England Journal of Medicine
  16. 16. Efectos sobre el metabolismo• La depleción de potasio inhibe la secreción de insulina.• La hiperpotasemia aumenta la tasa de secreción de insulina mediante el cambio del potencial de membrana de las células beta pancreáticas.• La insulina causa la liberación de óxido nítrico provocando vasodilatación en la hipertensión primaria, esta alterado este mecanismo.
  17. 17. Uso clínico para la prevención y tratamiento• Ingesta de sodio: – 65 mmol por día (aproximadamente 3,8 g de cloruro de sodio por día) para adultos de 50 años de edad o menos – 55 mmol por día (aproximadamente 3,2 g de cloruro de sodio al día) para adultos 51 a 70 años de edad – 50 mmol por día (aproximadamente 2,9 g de cloruro de sodio por día) para los 71 años de edad o más. • Ingesta de potasio: • Al menos 120 mmol de potasio por día (aproximadamente 4,7 g de potasio por día), excepto deportista, IRC, entre otros.
  18. 18. RECURSOSFISIOPATOLOGIA DE LAS CARDIOPATIAS, 4TA EDICIONLEONARDDO S.LILLYWOLTERS KLUWER

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