Palabras clave
enfermedad renal crónica
diálisis
hipertensión resistente
proteinuria
albuminuria
inhibidores de la enzima convertidora
Cómo citar
Resumen
Contexto: la hipertensión arterial (HTA) en el paciente con enfermedad renal crónica (ERC) tiene unas particularidades que la hacen diferente del trastorno hipertensivo de la población general. Las diferencias son evidentes desde los datos epidemiológicos, pasando por las alteraciones patogénicas, las metas tensionales y las aproximaciones farmacológicas.
Objetivo: con esta revisión narrativa se busca hacer una descripción detallada de los matices que hacen especial la HTA del paciente con ERC.
Metodología: se realizó una búsqueda no sistemática en la base de datos PubMed incluyendo ensayos clínicos, artículos de revisión y metaanálisis con relación a la HTA del paciente con ERC, desde estadios tempranos hasta diálisis.
Resultados: se incluyeron 40 referencias bibliográficas. La frecuencia de la HTA en el paciente con ERC en diálisis llega a ser tres veces más prevalente cuando se compara con la población general. Los mecanismos causales de la HTA en el paciente con ERC son múltiples y complejos, estos incluyen: hiperactividad simpática, activación del sistema renina angiotensina aldosterona, retención de sodio y agua, alteraciones vasculares y disfunción endotelial; mientras que la hipertensión resistente (HR) se presenta en un 13?% de la población general, en los pacientes con ERC llega a ocurrir en un 40?%. La ERC produce modificaciones en la farmacocinética y farmacodinamia de los antihipertensivos, que es preciso conocer para un adecuado manejo de la HTA en el paciente renal crónico.
Conclusiones: el control adecuado de las cifras tensionales es la piedra angular del manejo de la nefroprotección. La HTA del paciente renal crónico tiene unas características particulares que es necesario conocer para lograr un adecuado control.
Citas
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