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Perspectiva Clínica sobre el Tratamiento Antihipertensivo en Adultos con Hipertensión Grado 1 y Riesgo Cardiovascular Bajo-Moderado: Consulta internacional de expertos
Resumen
Resumen.
La hipertensión arterial es el principal factor de riesgo de la carga global de las enfermedades. Una pregunta en debate es si la hipertensión arterial grado 1 (140-159/90-99 mm Hg) con riesgo cardiovascular (RCV) total bajo (mortalidad cardiovascular <1% a los 10 años) a moderado (mortalidad cardiovascular >1% and <5% a los 10 años) debe ser tratada con agentes antihipertensivos. Un proceso de consulta virtual internacional fue realizado para resumir las opiniones de los expertos seleccionados. Después del análisis holístico de todos los elementos epidemiológicos, clínicos, psicosociales y de salud pública, este proceso de consulta llegó al siguiente consenso para adultos hipertensos <80 años de edad: 1) La interrogante de si el tratamiento medicamentoso en la hipertensión grado 1 debe ser precedido por un periodo de algunas semanas o meses durante el cual solo se recomienden medidas sobre el estilo de vida no está basada en evidencia “directa” (sino en extrapolaciones). Este consenso recomienda reservar cierto periodo de tiempo para solo cambios en el estilo de vida, únicamente en los pacientes con hipertensión grado 1 “aislada” (hipertensión grado 1 no complicada con RCV total absoluto bajo, y sin otros factores de RCV mayores ni modificadores del riesgo). 2) El inicio del tratamiento antihipertensivo medicamentoso en pacientes con hipertensión grado 1 y RCV total absoluto moderado no debe demorarse. 3) Los hombres ≥ 55 años y las mujeres ≥ 60 años con hipertensión grado 1 no complicada deben ser automáticamente clasificados dentro de la categoría de RCV total absoluto moderado, incluso en ausencia de otros factores de riesgo mayores y modificadores del riesgo. 4) Las estatinas deben tenerse en cuenta junto con la terapia antihipertensiva, independientemente de los valores de colesterol, en pacientes con hipertensión grado 1 y RCV total absoluto moderado.
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