Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- presión arterial sistólica (PA) ≥130 mmHg o diastólica ≥80 mmHg
- retinopatía
Other diagnostic factors
- cefalea
- cambios en la visión
- disnea
- dolor torácico
- déficit sensorial o motor
Risk factors
- obesidad
- ejercicio aeróbico <3 veces/semana
- consumo de alcohol moderado/elevado
- síndrome metabólico o síndrome cardiovascular-renal-metabólico (CRM)
- diabetes mellitus
- raza negra
- edad >60 años
- antecedentes familiares de hipertensión o enfermedad coronaria crónica
- apnea del sueño
- ingesta de sodio >1.5 g/día
- bajo consumo de frutas y verduras
- dislipidemia
- tabaquismo
Diagnostic tests
1st tests to order
- cociente albúmina/creatinina urinario (CACu)
- electrocardiograma (ECG)
- perfil metabólico en ayunas con tasa de filtración glomerular estimada (TFG)
- perfil lipídico
- análisis de orina
- hemoglobina
- hormona estimulante de la tiroides
Tests to consider
- actividad de la renina plasmática
- aldosterona plasmática
- ultrasonido renal dúplex/angiografía por resonancia magnética de arterias renales/angiografía por tomografía computerizada
- detección de feocromocitoma a través de una muestra de orina de 24 horas
- metanefrinas fraccionadas en plasma
- cortisol libre urinario de 24 horas
- estudio del sueño
- ecocardiografía
Treatment algorithm
sin nefropatía crónica ni comorbilidad relacionada con la enfermedad cardiovascular (ECV): hipertensión en estadio 1 y menor riesgo de ECV y sin diabetes
sin enfermedad renal crónica o comorbilidad relacionada con la enfermedad cardiovascular (ECV): mayor riesgo de ECV o con diabetes
enfermedad coronaria crónica concomitante sin insuficiencia cardíaca congestiva
insuficiencia cardiaca (IC) concomitante
hipertrofia ventricular izquierda concomitante sin enfermedad coronaria crónica
nefropatía crónica concomitante sin enfermedad cardiovascular
fibrilación auricular concomitante sin otra comorbilidad
refractario/resistente a la terapia triple optimizada en cualquier etapa
Contributors
Authors
Jeffrey Brettler, MD, FASH
Internal Medicine
Regional Hypertension Co-lead, Kaiser Permanente Southern California, Los Angeles
Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena
CA
Disclosures
JB declares that he has no competing interests.
Acknowledgements
Dr Jeffrey Brettler would like to gratefully acknowledge Dr Joel Handler, Dr Jonathan N. Bella, Dr Moustapha Atoui, Dr Liran Blum, and Dr Michael A. Spinelli, previous contributors to this topic.
Disclosures
JH, JNB, MA, LB, and MAS declare that they have no competing interests.
Peer reviewers
Isla Mackenzie, MBChB, PhD, FRCP
Clinical Senior Lecturer in Clinical Pharmacology and Honorary Consultant Physician
University of Dundee
Dundee
UK
Disclosures
IM is an elected member of the British Hypertension Society Executive Committee.
Syed Wamique Yusuf, MRCPI, FACC
Associate Professor
Department of Cardiology
University of Texas MD Anderson Cancer Center
Houston
TX
Disclosures
SWY declares that he has no competing interests.
Melvin Lobo, MBChB, PhD, MRCP
Director Barts Blood Pressure Centre of Excellence
NHS Reader in Cardiovascular Medicine
Department of Clinical Pharmacology
William Harvey Heart Centre
London
UK
Disclosures
ML is a consultant for ROX Medical. ML receives honorarium from Cardiosonic, St. Jude Medical, and institutional grant/research support from Medtronic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 ESC guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024 Oct 7;45(38):3912-4018.Full text Abstract
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.Full text Abstract
Rabi DM, McBrien KA, Sapir-Pichhadze R, et al. Hypertension Canada's 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Can J Cardiol. 2020 May;36(5):596-624.Full text Abstract
Wright JT Jr, Williamson JD, Whelton PK, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015 Nov 26;373(22):2103-16.Full text Abstract
Williams B, MacDonald TM, Morant S, et al; British Hypertension Society's PATHWAY Studies Group. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet. 2015 Nov 21;386(10008):2059-68.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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