Urgencias Cardiovasculares: HIPERTENSIÓN ARTERIAL

KWWSZZZHOSUDFWLFDQWHJDOHRQFRP
8UJHQFLDV&DUGLRYDVFXODUHV
+,3(57(16,Ï1$57(5,$/
$LWRU(W[HEHUULD*DULQ'LSORPDGRHQ(QIHUPHUtD
KWWSHVJHRFLWLHVFRPVLPSOH[
*HQHUDOPHQWHVHFRQVLGHUDTXHKD\+7$FXDQGRODSUHVLyQGLDVWyOLFDGHXQSDFLHQWHVH
PDQWLHQHSRUHQFLPDGHPP+J
/D+7$SXHGHVHUSULPDULDRVHFXQGDULDDRWUDVFRQGLFLRQHV
$SUR[LPDGDPHQWHHOGHODV+7$VRQKLSHUWHQVLRQHVHVHQFLDOHVTXHQRWLHQHQ
FDXVDFRQRFLGD
/DKLSHUWHQVLyQHVODFDXVDSULQFLSDOGHHQIHUPHGDGHVFDUGLRYDVFXODUHVLQVFRURQDULD
LQVFDUGLDFDLFWXVHLQVXILFLHQFLDUHQDO
/DVHQIHUPHGDGHVTXHHVWiQDVRFLDGDVFRQODKLSHUWHQVLyQ&RDUWDFLyQGHDRUWD
HVWHQRVLVDyUWLFDDUWHULRHVFOHURVLVVtQGURPHGH&XVKLQJJORPHUXQHIULWLVOXSXV
HULWHPDWRVRKLSHUWHQVLyQPDOLJQDIHRFURPRFLWRPDDOGRVWHURQLVPRSULPDULR
SLHORQHIULWLVHVFOHURGHUPLDHWF
),6,23$72/2*Ë$
x
x
x
x
/DSUHVLyQDUWHULDOGHSHQGHGHGRVIDFWRUHVIOXMR\UHVLVWHQFLD(OIOXMR
VDQJXtQHRGHSHQGHDVXYH]GHOJDVWRFDUGLDFRIXHU]DIUHFXHQFLDULWPR
FDUGLDFR\YROXPHQVDQJXtQHR/DUHVLVWHQFLDDOIOXMRGHSHQGHVREUHWRGRGHO
GLiPHWURGHORVYDVRVVDQJXtQHRV\HQPHQRUPHGLGDGHODYLVFRVLGDGGHOD
VDQJUH
/DGLODWDFLyQ\FRQWUDFFLyQGHODVDUWHULDVSHULIpULFDVSXHGHQFRQWURODUVH
PHGLDQWHYDULRVPHFDQLVPRVHVWLPXODFLyQGHOVLVVLPSiWLFR\DFWLYDFLyQGHO
VLVUHQLQD DQJLRWHQVLQD
/DHVWLPXODFLyQGHOVLVQHUYLRVRVLPSiWLFRFDXVDOLEHUDFLyQGHQRUDGUHQDOLQD\
DGUHQDOLQD/DDGUHQDOLQDDXPHQWDODIXHU]DGHFRQWUDFFLyQFDUGLDFDDOPLVPR
WLHPSRHVWUHFKDORVYDVRVORTXHSURYRFDDXPHQWRGHODSUHVLyQDUWHULDO
/DDFWLYDFLyQGHOVLVUHQLQDDQJLRWHQVLQD/DDQJLWHQVLQDHVXQYDVRFRQVWULFWRU
\UHWLHQHVDO\DJXDSRUWDQWRDXPHQWDHOYROXPHQYDVFXODUSURYRFDQGRDXPHQWR
GHODSUHVLyQDUWHULDO
&203/,&$&,21(6
&RQKLSHUWHQVLyQSURORQJDGDHOWHMLGRHOiVWLFRGHODVDUWHULRODVVHYXHOYHXQWHMLGR
FROiJHQRILEURVRSRUORTXHODVSDUHGHVGHORVYDVRVPHQRVHOiVWLFDVRIUHFLHQGRPDV
UHVLVWHQFLDVDOIOXMRGHVDQJUH
&RPRFRQVHFXHQFLDHO9HQWUtFXORL]GRGHEHGHGHVSOHJDUPDVIXHU]DSDUDODH[SXOVLyQ
GHYROXPHQGHVDQJUHHVWRDODODUJDSURYRFDTXHKD\DXQDKLSHUWURILDGHOYHQWUtFXOR
6HGDQSUREOHPDVGHDQJLQDGHSHFKRRSXHGHSURGXFLUVHXQ,$0SRUVXPLQLVWUR
LQDGHFXDGRGHVDQJUHDWUDYpVGHODVDUWHULDVFRURQDULDVDGHPiVGH,LQVXILFLHQFLD
FDUGLDFDSRUODKLSHUWURILDGHOYHQWUtFXORL]GR
&/$6,),&$&,Ï1
x
x
x
x
x
+7$/$%,/ &LIUDVRVFLODQWHVGH7$FRQHOHYDFLRQHVRFDVLRQDOHV\WUDQVLWRULDV
VLQUHSHUFXVLRQHV&RUUHVSRQGHDSHUVRQDVFRQHVWUpVRSHUVRQDVDQVLRVDV
+7$/,0,7(7$PDQWHQLGDVHQHOOLPLWHJHQHUDOPHQWHQRSUHFLVDQ
WUDWDPLHQWR
+7$*5$9('LDVWyOLFDVVXSHULRUHVDPP+JHQDXVHQFLDGHWUDWDPLHQWR
+7$5()5$&7$5,$3DFLHQWHVFRQ7$QRFRQWURODGDSHVHDOWUDWDPLHQWR
+7$ 0$/,*1$$FDUUHDQOHVLRQHVHQGLIHUHQWHVyUJDQRV
9$/25$&,Ï1
5HFRJHUGDWRVVXEMHWLYRV
x
x
x
x
+,3(57(16,Ï1$57(5,$/
&20,(1=2<)5(&8(1&,$FHIDOHDVYpUWLJRVFRQJHVWLyQIDFLDOHStVWDVLV
HSLVRGLRVGHYLVLyQERUURVD
&$0%,26'(3(62
+È%,726$/,0(17,&,26HVSHFLDOPHQWHVDO\JUDVDVVDWXUDGDV
(675(6$'2WUDEDMRYLGDGLDULD
GDWRVREMHWLYRV
x
x
x
$1$/Ë7,&$'(6$1*5(KHPRJUDPDELRTXtPLFD
5;'(7Ï5$;SDUDFRPSUREDUWDPDxRGHOFRUD]yQ\YDVFXODUL]DFLyQSXOPRQDU
$1È/,6,6'(25,1$SDUDGHWHFWDUSRVLEOHIHRFURPRFLWRPDFDWHFRODPLQDVR
SDUDGHWHFWDUSRVLEOH6tQGURPHGH&XVKLQJ
+LVWRULDOGHOSDFLHQWH
x
2%7(1(5+,6725,$'(/3$&,(17( VLHVSRVLEOHSDUDDYHULJXDU
R $QWHFHGHQWHV
R (QIHUPHGDGHVDFWXDOHV
R 0HGLFDFLyQTXHVHDGPLQLVWUD
R )DFWRUHVGHULHVJR
$&7,9,'$'(6'((1)(50(5Ë$
$&78$&,21(6
+,3(57(16,Ï1$57(5,$/
(QVLWXDFLRQHVHQODVTXHODKLSHUWHQVLyQHVJUDYH
x
x
x
x
x
5HSRVRDEVROXWR
7RPDUOD7$IUHFXHQWHPHQWH
&RQWUROGHOUHVWRGHODVFRQVWDQWHVFRPSUREDQGRDOJXQDDOWHUDFLyQGHOD)&
)5\WHPSHUDWXUD
0RQLWRUL]DFLyQFDUGLDFDGHOSDFLHQWH
$GPLQLVWUDFLyQGHR[LJHQRVHJ~QSUHVFULSFLyQPpGLFD
0$7(5,$/<352&(',0,(1726
x
9HQRFOLVLV\H[WUDFFLyQGHDQDOtWLFDVVDQJXtQHDVKHPRJUDPD\ELRTXtPLFD
(IHFWXDU(&*GHGHULYDFLRQHVSDUDGHVFDUWDUSRVLEOHVDOWHUDFLRQHVGHOULWPR
RVLJQRVGHLVTXHPLDPLRFiUGLFD
5HDOL]DU5;GHWyUD[SDUDGHVFDUWDUDOWHUDFLRQHVFDUGLDFDVRSXOPRQDUHV
x
3URSRUFLRQDUWUDQTXLOLGDGDOSDFLHQWH
x
x
)$925(&(5(/%,(1(67$5
75$7$0,(172)$50$&2/Ï*,&2
/RVIiUPDFRVKLSRWHQVRUHVPDVXWLOL]DGRVVRQ
',85e7,&26
%(7$%/248($17(6
$/)$%/248($17(6
&$/&,2$17$*21,67$6
R
R
3URSRQROROVXPLDO
$WHQROROWHQRUPLQ
R
3UD]RVLQPLQLSUHV
R
R
1LIHGLSLQDDGDODW
9HUDSDPLOPDQLGRQ
,(&$
9$62',/$7$'25
9$62',/$7$'25(6327(17(6
R
R
&DSWRSULOFDSRWHQ
(QDODSULOUHQLWHF
R
+LGUDODFLGDKLGUDSUHV
1LWURJOLFHULQD
x
x
x
SURGXFHYDVRGLODWDFLyQSRUUHODMDFLyQGLUHFWDGHOP~VFXORYDVFXODU$GRVLV
EDMDVSURGXFHYDVRGLODWDFLyQYHQRVDGLVPLQX\HQGRODSUHFDUJD$GRVLVDOWDV
WDPELpQSXHGHWHQHUXQHIHFWRYDVRGLODWDGRUDUWHULDOGLVPLQX\HQGRODV
UHVLVWHQFLDVYDVFXODUHVVLVWpPLFDV3URGXFHDVLPLVPRYDVRGLODWDFLyQFRURQDULD
DXPHQWDQGRHOIOXMRVDQJXtQHR\HODSRUWHGHR[tJHQRDOPLRFDUGLR
/DQLWURJOLFHULQD,9VHHPSOHDHQHOWUDWDPLHQWRGHODLQVXILFLHQFLDFDUGLDFD
FRQJHVWLYDFRQHGHPDGHSXOPyQHQODDQJLQDLQHVWDEOH\HOLQIDUWRGH
PLRFDUGLR\HQVLWXDFLRQHVFRPRODKLSHUWHQVLyQSXOPRQDUVHYHUD\WUDVFLUXJtD
FDUGLDFD
/DGRVLVLQLFLDOHVGHXJUPLQTXHVHSXHGHLUDXPHQWDQGRKDVWD
XJUPLQ
1LWURSUXVLDWR
x
x
x
(VXQSRWHQWHYDVRGLODWDGRUFRQVLGHUDGRHOQ~PHURXQRHQFXDQWRDHILFDFLD
GHPRVWUDGDFRQVWLWX\HHOSXQWRGHFRPSDUDFLyQSDUDFXDOTXLHUQXHYRIiUPDFR
YDVRGLODWDGRU3URGXFHUHODMDFLyQGLUHFWDGHOP~VFXOROLVRYDVFXODUWDQWRDUWHULDO
FRPRYHQRVRFRQXQHIHFWRHTXLOLEUDGRGHGLVPLQXFLyQGHODSUHFDUJD\OD
SRVFDUJDPHMRUDQGRODFRQJHVWLyQSXOPRQDU\DXPHQWDQGRHOJDVWRFDUGLDFR(O
FRPLHQ]RGHODDFFLyQHVUiSLGR\ODFRUWDYLGDPHGLDTXHSRVHHXQRV
PLQXWRVSHUPLWHQDMXVWDUODGRVLVSDUDREWHQHUHOHIHFWRKHPRGLQiPLFRGHVHDGR
SRUHVWRPLVPRODGHVDSDULFLyQGHOHIHFWRWUDVVXVXVSHQVLyQHVUiSLGD
6XHPSOHRHVWiLQGLFDGRHQHOIDOORFDUGLDFRVHYHURGHFXDOTXLHURULJHQWDQWRVL
FXUVDFRQLQVXILFLHQFLDFDUGLDFDFRQJHVWLYDFRPRFRQEDMRJDVWRFDUGLDFR
VLHPSUHTXHQR H[LVWDKLSRWHQVLyQ7DPELpQHVHOWUDWDPLHQWRGHHOHFFLyQGHODV
HPHUJHQFLDVKLSHUWHQVLYDV
/DGRVLVLQLFLDOHVGHXJUPLQODFXDOVHYDDXPHQWDQGRKDVWDODFRQVHFXFLyQ
GHOHIHFWRGHVHDGR
x
(VQHFHVDULRWHQHUHQFXHQWDDODKRUDGHDGPLQLVWUDUQLWURSUXVLDWRODVVLJXLHQWHV
FRQVLGHUDFLRQHV
$&DGDYLDOFRQWLHQHPJ\VHGHEHGLOXLUHQ6*R
6)QXQFDHQVXVWDQFLDVDOFDOLQDV\DTXHSUHFLSLWDUtD
%6HGHEHHPSOHDUHQLQIXVLyQ,9FRQWLQXDEFRQERPED
SDUDFRQWURODUODGRVLV
&(OQLWURSUXVLDWRHVIRWRVHQVLEOH3DUDHYLWDUVX
GHJUDGDFLyQKD\TXHUHFXEULUODVROXFLyQFRQXQD
HQYROWXUDRSDFD8QDYH]SUHSDUDGDODVROXFLyQWDPELpQ
VHUHDOL]DXQSURFHVRGHGHVQDWXUDOL]DFLyQHVSRQWiQHDSRU
ORTXHGHEHFDPELDUVHFDGDKRUDVSDUDHYLWDUODSpUGLGD
GHHILFDFLD
'(OSULQFLSDOHIHFWRVHFXQGDULRHVODKLSRWHQVLyQGHELGR
DVXSRWHQWHDFFLyQYDVRGLODWDGRUD
(6XUHWLUDGDVHGHEHUHDOL]DUGHPDQHUDJUDGXDOSDUD
HYLWDUTXHVHSURGX]FDXQHIHFWRUHERWH
2%6(59$&,21(6'((1)(50(5Ë$
x
x
x
x
x
x
9LJLODUOD7$IUHFXHQWHPHQWH
'HWHUPLQDUODIUHFXHQFLDULWPR\YROXPHQGHOSXOVR
2EVHUYDUHOPRQLWRUFDUGLDFRHQEXVFDGHSRVLEOHVDOWHUDFLRQHVGHOULWPR\
VLJQRVGHLVTXHPLDSDFLHQWHVSRWHQFLDOHVGHSDGHFHU,$0
2EVHUYDUHOQLYHOGHFRQFLHQFLD/RVSDFLHQWHVFRQKLSHUWHQVLyQWLHQHQHOULHVJR
GHSDGHFHUKHPRUUDJLDFHUHEUDO
2EVHUYDUVLSUHVHQWDVLJQRVGHKHPRUUDJLD3DFLHQWHVFRQULHVJRGHSUHVHQWDU
URWXUDGHDQHXULVPDHStVWDVLVHWF
9LJLODUORVSRVLEOHVHIHFWRVVHFXQGDULRVGHOWUDWDPLHQWRIDUPDFROyJLFRFRPR
KLSRWHQVLyQ QDXVHDVYyPLWRVFHIDOHDV
('8&$&,Ï16$1,7$5,$
x
x
x
x
x
x
([SOLFDUODVFDXVDVGHOSUREOHPDORVIDFWRUHVTXHFRQWULEX\HQDODKLSHUWHQVLyQ
LQFOX\HQ
R 2EHVLGDG
R DXPHQWRGHODLQJHVWLyQGHVRGLR
R WDEDFRHWF
$FRQVHMDUHYLWDUVLWXDFLRQHVDOWDPHQWHHPRFLRQDOHV
5HVDOWDUHOSHOLJURGHOSHVRFRUSRUDOH[FHVLYR
,QIRUPDUGHTXHVHGHEHHYLWDUODWRVLQWHQVD\HVIXHU]RVH[FHVLYRVDXPHQWDOD
SUHVLyQLQWUDYDVFXODU
$FRQVHMDUODUHDOL]DFLyQGHHMHUFLFLRItVLFRPRGHUDGR
([SOLFDUODUD]yQGHOWUDWDPLHQWR\HOHIHFWRHVSHUDGR