The document defines hypertension as a sustained elevation of systolic, diastolic, or both blood pressures that affects a large portion of the adult population, especially the elderly. It presents guidelines for classifying normal, prehypertension, stage 1 hypertension, and stage 2 hypertension based on blood pressure readings. It also discusses the epidemiology, etiology, physical findings, clinical presentation, and pharmacological treatment of hypertension. Common antihypertensive drug classes mentioned include beta blockers, diuretics, calcium channel blockers, ACE inhibitors, ARBs, renin inhibitors, alpha blockers, and central alpha agonists.

1. HIPERTENSION
ARTERIAL
09/06/2014

2. DEFINICION
• La hipertensión arterial (HTA) es una elevación
sostenida de la presión arterial sistólica, diastólica o de
ambas que afecta a una parte muy importante de la
población adulta, especialmente a los de mayor edad.
• Su importancia reside en el hecho de que, cuanto mas
elevadas sean las cifras de presión tanto sistólica como
diastólica, más elevadas son la morbilidad y la
mortalidad de los individuos.

3. • The seventh report of Joint
National Committee in 2003
on Prevention, Detection,
Evaluation, and Treatment of
High Blood Pressure (JNC 7)
described normal blood
pressure (BP) in adults as
systolic BP, 120 mm Hg and
diastolic ,80 mm Hg.
HTA
PA sistólica (PAS) > 140 mm Hg o
PA diastólica (PAD) > 90 mm Hg o ambas.
Prehypertension is defined as:
Systolic BP between 120-139 mm Hg or
Diastolic between 80-89 mm Hg.
Stage 1 hypertension (HTN) is:
systolic BP from 140-159 mm Hg or
diastolic BP from 90-99 mm Hg.
Stage 2 hypertension is:
Systolic BP > 160 mm Hg or
Diastolic BP > 100 mm Hg
HYPERTENSION

5. EPIDEMIOLOGIA
• La HTA es el principal factor
relacionado con la mortalidad en todo
el mundo.
• Las cifras de presión aumentan
progresivamente con la edad, por lo
que la prevalencia de HTA depende
extraordinariamente del segmento
etario analizado.
• De muy baja prevalencia en individuos
por debajo de los 30 años, dicha
prevalencia puede alcanzar hasta el
80% en los mayores de 80 años.
• Todos los grupos étnicos sufren HTA.
PREVALENCE:
Based on NHANES data in 2005
to 2008, approximately 68
million (31%) U.S. adults have
hypertension and only 31
million (46%) have it well
controlled. There are around 1
billion individuals worldwide
who meet the criteria for
diagnosis of HTN.
PEAK PREVALENCE: Males and
the elderly

6. Etiopatogenia
• Factores etiológicos:
* Genética (familiares 1° grado)
• Factores ambientales:
Sedentarismo, mayor ingesta calórica, sal y grasas
saturadas.
• Factores patogenéticos
• Sistema nervioso simpático: hiperactividad
• Sistema renina-angiotensina
• Disfunción y lesión endotelial
• Cambios estructurales en las arterias: hipertrofia de la
capa media, rigidez de grandes arterias.

8. CLASIFICACION
- Hipertensión esencial:
No tiene causa específica
- Hipertensión secundaria:
Tiene causa conocida ( 10% )

10. ETIOLOGY
• Essential (primary) HTN (85%)
• Secundary Hypertension (15%):
a) Drug induced or drug related (5%)
• 1. NSAIDs
• 2. Oral contraceptives
• 3. Corticosteroids
b) Renal HTN (5%)
• 1. Renal parenchymal disease (3%)
• 2. Renovascular hypertension (RVH) (2%)
c) Endocrine (<2%)
• 1. Primary aldosteronism (0.5%)
• 2. Pheochromocytoma (0.2%)
• 3. Cushing’s syndrome and long-term steroid therapy (0.2%)
• 4. Hyperparathyroidism or thyroid disease(0.2%)
d) Coarctation of the aorta (0.2%)

11. PHYSICAL FINDINGS & CLINICAL
PRESENTATION
• The BP should be measured with an appropriately sized cuff (bladder of
the cuff should cover at least two thirds of the circumference of the arm)
and in both arms (the higher of the readings being used).
• The BP should be measured twice on each visit, and seperated by at least
1 to 2 min to allow the return of trapped blood. If the values differ, use the
higher value.
• Postural BP change should always be recorded in elderly to diagnose
postural hypotension and is best assessed by going from the lying to the
standing position and should include information on change in heart rate
with change in position.
• A diagnosis of HTN may be established if the BP is markedly elevated
(180/110 mm Hg) or has evidence of end organ damage; otherwise such a
diagnosis should wait until BP is found elevated on at least two occasions
measured over a period of 1 wk or more.
• Measure heart rate, height, weight, body mass index, and waist
circumference.

12. PHYSICAL FINDINGS & CLINICAL
PRESENTATION
• Examine skin for the presence of cafe-au-lait spots (neurofibromatosis), uremic
appearance (renal failure), and violaceous striae (Cushing’s syndrome).
• Perform careful funduscopic examination; check for papilledema, retinal
exudates, hemorrhages, arterial narrowing, arteriovenous compression.
• Examine neck for carotid bruits, distended neck veins, and enlarged thyroid gland.
• Perform extensive cardiopulmonary examination: check for loud aortic
component of S2, S4, ventricular lift, murmurs, and arrhythmias.
• Palpate abdomen for renal masses (pheochromocytoma, polycystic kidneys), and
auscultate for bruit over the aorta and renal arteries.
• Examine arterial pulses (dilated or absent femoral pulses and BP greater in upper
extremities than lower extremities suggest aortic coarctation).
• Look for truncal obesity (Cushing’s syndrome) and pedal edema (congestive heart
failure [CHF]).
• The clinical evaluation should help to determine if the patient has primary or
secondary (possibly reversible) HTN, if there is target organ disease present, and if
there are additional cardiovascular risk factors.
• Table 1-174 provides a guide to evaluation of identifiable causes of hypertension.

17. TRATAMIENTO FARMACOLOGICO
1. BETA-BLOQUEANTES
2. DIURETICOS
3. CALCIO ANTAGONISTAS
4. INHIBIDORES DE LA ECA
5. ARA II
6. INHIBIDORES DE RENINA.
7. BLOQUEADORES ALFA-ADRENERGICOS.
8. ANTAGONISTAS ALFA-CENTRALES.
9. BLOQUEADORES COMBINADOS DE
RECEPTORES ALFA Y BETA ADRENÉRGICOS:

18. ANTAGONISTAS BETA ADRENERGICOS
ATENOLOL
PROPANOLOL
NADOLOL
TIMOLOL
PINDOLOL
METOPROLOL
ACEBUTOLOL
PRACTOLOL
ESMOLOL
LABETALOL
CARVEDILOL
CELIPROLOL

19. DIURETICOS
- TIAZIDAS: Hidroclorotiazida, Clortalidona
- DIURETICOS DE ASA: Furosemida,
bumetanida
- DIURETICOS AHORRADORES DE K :
Amilorida, triamtereno, espironolactona

20. BLOQUEADORES DE LOS CANALES DEL
CALCIO
• Verapamil – diltiazem
• Dihidropiridinas:
• Amlodipino – Nifedipino - Isradipino.
Mecanismo de Acción:
Inhibición del ingreso del Ca
intracelular en el músculo liso arterial

21. INHIBIDORES DE LA EZ CONVERTIDORA DE
ANGIOTENSINA
(IECA)
- Captopril
- Enalapril
- Lizinopril
- Quinapril
- Benazepril
- Fosinopril
- Trandolapril

22. ANTAGONISTAS DE LOS RECEPTORES DE
ANGIOTENSINA II
- Losartan
- Valsartan
- Candesartan
- Irbesartan
- Telmisartan
- Eprosartan

23. SIMPATICOLITICOS DE ACCION
CENTRAL
- METILDOPA
- CLONIDINA

24. BLOQUEADORES DE LOS RECEPTORES α1
ADRENERGICOS
– PRAZOCIN
–TERAZOSINA
–DOXAZOCINA