Hipertensão resistente: abordagem clínica

Autores

  • Elizabeth Silaid Muxfeldt Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina - Rio de Janeiro (RJ), Brasil. http://orcid.org/0000-0003-3853-7842
  • Bernardo Fróes Chedier Barreira Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina - Rio de Janeiro (RJ), Brasil. http://orcid.org/0000-0001-8381-9561
  • Cibele Isaac Saad Rodrigues Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde (FCMS) - Sorocaba (SP), Brasil. http://orcid.org/0000-0001-9490-7997

DOI:

https://doi.org/10.23925/1984-4840.2018v20i3a3

Palavras-chave:

pressão sanguínea, hipertensão, sistema nervoso simpático, hiperaldosteronismo, resistência a medicamentos, anti-hipertensivos

Resumo

Hipertensão arterial resistente é definida como a pressão arterial de consultório não controlada, apesar do uso de três ou mais anti-hipertensivos, incluindo, preferencialmente, um diurético. Indivíduos em uso de quatro ou mais medicamentos com controle pressórico também são considerados hipertensos resistentes. Por sua vez, hipertensão refratária é a pressão arterial não controlada, apesar do uso de cinco ou mais drogas, incluindo um tiazídico de ação prolongada e um antagonista da aldosterona. Sua prevalência vem crescendo com o envelhecimento da população e o avanço da obesidade, estando relacionada às altas taxas de morbidade e mortalidade de origem cardiovascular e renal. A abordagem diagnóstica se baseia em quatro pontos: afastar pseudorresistência, identificar o fenômeno do jaleco branco, investigar causas secundárias e identificar lesões subclínicas para estratificação do risco cardiovascular. O objetivo terapêutico é o controle da pressão arterial de 24 horas. Mudanças de estilo de vida devem ser implementadas e as três primeiras drogas devem incluir um diurético adequado, um inibidor do sistema renina-angiotensina-aldosterona e um bloqueador de canais de cálcio. Persistindo o descontrole pressórico, adicionamos a quarta droga: espironolactona. Quanto aos hipertensos refratários, novas modalidades terapêuticas vêm sendo desenvolvidas, como a denervação renal e a estimulação do barorreflexo.

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2018-12-03

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Muxfeldt ES, Barreira BFC, Rodrigues CIS. Hipertensão resistente: abordagem clínica. Rev. Fac. Ciênc. Méd. Sorocaba [Internet]. 3º de dezembro de 2018 [citado 28º de março de 2024];20(3):128-37. Disponível em: https://revistas.pucsp.br/index.php/RFCMS/article/view/37646

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