Hipertensión arterial y diabetes en situaciones especiales y complicaciones crónicas: guías de recomendaciones para la práctica clínica 2015. Comité de hipertensión arterial y otros factores de riesgo cardiovascular. Sociedad Argentina de Diabetes
DOI:
https://doi.org/10.47196/diab.v50i1.73Palabras clave:
diabetes, hipertensión arterial, nefropatía, enfermedad cardiovascular, adulto mayorResumen
Introducción: la hipertensión arterial (HA) y la diabetes mellitus (DM) son enfermedades de alta prevalencia y frecuentemente asociadas.
Objetivo: brindar los conocimientos para la práctica clínica que favorezca la toma de decisiones diagnósticas y terapéuticas adecuadas.
Metodología: basándonos en la evidencia disponible, los grandes ensayos clínicos publicados en los últimos cuatro años y la adaptación de los recursos diagnósticos y terapéuticos de nuestro país, se elaboraron estas “Recomendaciones para la Práctica Clínica”, enfocando situaciones especiales como embarazo, niñez, adulto mayor y complicaciones crónicas.
Conclusiones: la HA aumenta la progresión y el desarrollo de las complicaciones crónicas micro y macrovasculares. El impacto del tratamiento de la HA es significativo en la reducción de la morbimortalidad de las personas con DM y en la aparición y progresión de las complicaciones micro y macrovasculares. En la mayoría de los adultos con HA y DM el objetivo es alcanzar una PA (presión arterial) <140/90 mmHg. Siendo las metas menos estrictas en los adultos mayores frágiles. En personas con trasplante renal, en RAC (relación albúmina/creatinina) >300 mg/g, en jóvenes, los objetivos podrían ser menores (<130-80 mmHg), si se logran sin efectos adversos asociados al tratamiento. Evitar PAD (presión arterial diastólica) <60 mmHg en personas mayores de 60 años.
La elección de fármacos dependerá de la edad, el momento biológico, si existe intolerancia o alguna contraindicación y acorde al objetivo terapéutico de cada complicación crónica. El tratamiento debe ser temprano y las metas terapéuticas deberán
ser individualizadas según grupo etario, comorbilidades y daño de órgano blanco.
Citas
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