1. Hipertensión Arterial 2008

3. Enfermedad Cardiovascular Edad y HTA

4. Vasan et al. JAMA 2002;287:1003 LIFETIME RISK OF DEVELOPING HYPERTENSION IN FRAMINGHAM SUBJECTS NORMOTENSIVE AT AGE 55 OR 65 65 55 65 55 Age 90 88 89 83 20 85 78 81 72 15 72 56 64 52 10 Men Women Interval (years) Percent Developing Hypertension

5. Enfermedad cardiovascular HTA y edad

6. White-Coat Effect with Age Mansoor et al. J Hum Hypertens 1996;10:87

9. Riesgos e Hipertensión

10. Racional para reducir la PA

12. Cambios en la clasificación de HTA

13. Guías de Nueva Zelanda

14. Guías de Nueva Zelanda

15. Guías europeas

18. White-Coat Effect with Age Mansoor et al. J Hum Hypertens 1996;10:87

19. Monitoreo ambulatorio domiciliario

22. Treatment Strategies and Risk Stratification JNC 6

23. Classification and Management of BP for adults *Treatment determined by highest BP category. † Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension. ‡ Treat patients with chronic kidney disease or diabetes to BP goal of <130/80 mmHg. JNC 7 slideset Two-drug combination for most † (usually thiazide-type diuretic and ACEI or ARB or BB or CCB). Yes or > 100 > 160 Stage 2 Hypertension Drug(s) for the compelling indications. ‡ Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. Yes or 90–99 140–159 Stage 1 Hypertension Drug(s) for compelling indications. ‡ No antihypertensive drug indicated. Yes or 80–89 120–139 Prehypertension Encourage and <80 <120 Normal With compelling indications Without compelling indication Initial drug therapy Lifestyle modification DBP* mmHg SBP* mmHg BP classification

24. Sudden Deaths by Time of Day Peckova et al. Circulation 1998;98:31

25. Low Dose Diuretics vs. Others From Psaty BM et al. JAMA 2003;289:2534

26. The Reasons Why Low-Dose Diuretics Should be Initial Therapy 1. They reduce cardiovascular morbidity and mortality. 2. They lower blood pressure, particularly in patients consuming excessive sodium. 3. They enhance the antihypertensive efficacy of all other antihypertensive drugs. 4. They rarely cause side effects. 5. They reduce calcium loss and osteoporosis. 6. They are relatively inexpensive.

28. Systolic and Diastolic Blood Pressure after Randomization N Engl J Med . 2003;348(7):583-592. Diastolic 6083 6035 5583 5487 4320 1183 Systolic 6083 6035 5585 5487 4323 1183 0 75 80 85 90 95 130 140 150 160 170 0 1 2 3 4 5 ACEI Diuretic

29. CV Events in Swedish Trial in Old Persons (Stop-2) Conventional Rx (diuretics and B-blockers) compared to ACE-Is and CCBs No difference in BP outcomes No overall difference in EVENTS Lancet 1999;354:751

32. Heart Outcomes Preventions Evaluation (HOPE) Study Events ACE-1 (Ramipril)* Regimen that did not include an ACE-1 No. Randomized 4645 4652 % Reduction in Risk - Ramipril:Other therapy MI, Stroke, CVD 22 CV death 25 MI 20 Stroke 31 Non-CV death +3 (NS) All cause mortality 16 *10 mg/day - 62.5% remained on Rx at 4.5 years New Engl J Med 11/10/99

34. En pacientes de alto riesgo (HOPE, IRMA, IDNT, RENAAL, and LIFE), el uso de un IECA (o un ARA) usualmente con un diuretico) reducen eventos CV mas que un regimen que no incluye estas medicaciones.

35. 2003 The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT),

36. Cumulative Event Rates for the Primary Outcome (Fatal CHD or Nonfatal MI) by ALLHAT Treatment Group Chlorthalidone Amlodipine Lisinopril Years to CHD Event 0 1 2 3 4 5 6 7 Cumulative CHD Event Rate 0 .04 .08 .12 .16 .2 0.81 0.99 (0.91-1.08) L / C 0.65 0.98 (0.90-1.07) A / C p value RR (95% CI)

41. Benefits of Lowering BP by Average Percent Reduction Stroke incidence 35–40% Myocardial infarction 20–25% Heart failure 50% -12 -4-5 About mmHg

43. JNC 7 Primary Rx recommends: