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Tratamiento de la hipertensión arterial en la enfermedad renal crónica
Resumen
La hipertensión arterial (HTA) es un síndrome cardiovascular progresivo que es ocasionado por etiologías complejas e interrelacionadas. Los marcadores tempranos del síndrome frecuentemente están presentes antes de que se eleve la presión arterial (PA); por lo tanto, la HTA no puede ser solamente clasificada por el umbral de elevación de la PA. Su progresión está fuertemente asociada con anormalidades estructurales y funcionales de la función cardiaca y vascular que dañan el corazón, el riñón, el cerebro, los vasos sanguíneos y otros órganos, y provocan morbilidad y muerte prematuras. Así, la PA es solamente un biomarcador de este síndrome cardiovascular, por lo que es de mayor utilidad considerar los patrones individuales de PA del enfermo en vez de un umbral de PA único. El estudio y tratamiento de la HTA en la enfermedad renal crónica (ERC) ha tenido avances, sobre todo en la población en diálisis. El uso de tecnología no invasiva para registrar la PA ha permitido reformar la atención médica de los enfermos en cuanto al diagnóstico, patrón circadiano, vigilancia clínica, prescripción farmacológica, pronóstico y riesgo de eventos cardiovasculares. La oportunidad en el diagnóstico y tratamiento supone un retardo en la aparición de complicaciones y en el inicio de la diálisis. El bloqueo del sistema renina-angiotensina-aldosterona (SRAA), la vigilancia periódica del peso seco en la población en diálisis y las intervenciones para modificar el estilo de vida son las maniobras con mayor impacto en la morbimortalidad de los enfermos.
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