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
Other diagnostic factors
- cefaleia
- alterações visuais
- dispneia
- dor torácica
- deficit sensorial ou motor
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
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
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
Treatment algorithm
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
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
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.
Differentials
- Hipertensão induzida por medicamento
- Doença renal crônica
- Estenose da artéria renal
More DifferentialsGuidelines
- Standards of care in diabetes
- Guidelines for the primary prevention of stroke
More GuidelinesPatient information
Pressão alta: o que é?
Pressão alta: perguntas a fazer ao seu médico
More Patient informationCalculators
Equações CKD-EPI de 2021 sem raça para taxa de filtração glomerular (TFG)
Taxa de filtração glomerular estimada pela equação de estudo em MDRD rastreável por IDMS
More CalculatorsVideos
Como realizar uma demonstração animada do ECG
More videosLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer