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Hipertensão essencial

Последний просмотренный: 16 Aug 2025
Last updated: 08 Jan 2025

Резюме

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • pressão arterial (PA) sistólica ≥130 mmHg ou PA diastólica ≥80 mmHg
  • retinopatia
Full details

Other diagnostic factors

  • cefaleia
  • alterações visuais
  • dispneia
  • dor torácica
  • deficit sensorial ou motor
Full details

Risk factors

  • obesidade
  • exercício aeróbio <3 vezes/semana
  • moderada/elevada ingestão de bebidas alcoólicas
  • síndrome metabólica ou síndrome cardiovascular-renal-metabólica
  • diabetes mellitus
  • ascendência negra
  • idade >60 anos
  • história familiar de hipertensão ou doença coronariana crônica
  • apneia do sono
  • ingestão de sódio >1.5 g/dia
  • baixa ingestão de frutas e vegetais
  • dislipidemia
  • tabagismo
Full details

Diagnostic investigations

1st investigations to order

  • relação albumina:creatinina urinária (RACU)
  • eletrocardiograma (ECG)
  • perfil metabólico em jejum com taxa de filtração glomerular (TFG) estimada
  • perfil lipídico
  • urinálise
  • hemoglobina
  • hormônio estimulante da tireoide
Full details

Tests to consider

  • atividade da renina plasmática
  • aldosterona plasmática
  • ultrassonografia duplex renal/ARM das artérias renais/angiotomografia
  • triagem de feocromocitoma na urina de 24 horas
  • metanefrinas fracionadas séricas
  • cortisol urinário livre de 24 horas
  • estudo do sono
  • ecocardiografia
Full details

Treatment algorithm

ACUTE

sem comorbidade relacionada a doença renal crônica ou doença cardiovascular (DCV): hipertensão de estágio 1 e risco mais baixo de DCV e sem diabetes

sem comorbidade relacionada a doença renal crônica ou doença cardiovascular (DCV): risco mais alto de DCV ou com diabetes

doença coronariana crônica concomitante sem insuficiência cardíaca congestiva

insuficiência cardíaca (IC) concomitante

hipertrofia ventricular esquerda concomitante sem doença coronariana crônica

doença renal crônica concomitante sem doença cardiovascular

fibrilação atrial concomitante sem outra comorbidade

ONGOING

refratários/resistentes à terapia tripla otimizada em qualquer 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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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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