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TRATAMIENTO DE LA HIPERTENSION ARTERIAL EN LA NEFROPATIA DIABETICA AVANZADA
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EL ÁCIDO ÚRICO SÉRICO ELEVADO AUMENTA EL RIESGO DE HIPERTENSIÓN ARTERIAL
Hypertension 71(1):78-86
Difundido en siicsalud: 10 jul 2019
EPISODIOS DE REFLUJO Y AUMENTO DE LA PRESIÓN ARTERIAL EN PACIENTES HIPERTENSOS
Journal of Clinical Gastroenterology 52(8):685-690
Difundido en siicsalud: 3 may 2019

TRATAMIENTO DE LA HIPERTENSION ARTERIAL EN LA NEFROPATIA DIABETICA AVANZADA

(especial para SIIC © Derechos reservados)
La nefropatía diabética es la primera causa de requerimiento de sustitución de la función renal. Se presenta el estado del conocimiento de la fisiopatología de la hipertensión arterial en el paciente con diabetes tipo 2 con nefropatía progresiva, actuando como factor de riesgo para esta progresión y para las complicaciones vasculares, para permitir la selección de la estrategia terapéutica más adecuada.
wasserman9_72712.jpg Autor:
Alfredo Wassermann
Columnista Experto de SIIC

Institución:
FEPREVA


Artículos publicados por Alfredo Wassermann
Coautor
Cristina Patricia Grosso* 
Médica Especialista en Medicina Interna, Nutrición y Diabetes, FEPREVA, Buenos Aires, Argentina*
Recepción del artículo
31 de Agosto, 2011
Aprobación
14 de Junio, 2012
Primera edición
1 de Agosto, 2012
Segunda edición, ampliada y corregida
31 de Agosto, 2012

Resumen
La diabetes afecta aproximadamente al 10% de la población adulta, por lo que constituye la etiología más frecuente de enfermedad renal entre los pacientes que requieren hemodiálisis. La hipertensión está frecuentemente asociada con la diabetes tipo 2, en la que se presenta como diagnóstico previo, concomitante o posterior, y a la diabetes tipo 1, como consecuencia de la nefropatía. La hipertensión incrementa el riesgo cardiovascular y acelera la progresión de la nefropatía, en tanto que su tratamiento retrasa los eventos cardiovasculares y renales. Los mecanismos principalmente involucrados en la hipertensión y progresión de la nefropatía son la expansión secundaria a la reabsorción incrementada de sodio y la sobreestimulación del sistema renina-angiotensina-aldosterona, y la vasoconstricción por desregulación de los moduladores de la resistencia vascular. Los objetivos generales del tratamiento antihipertensivo en el paciente con diabetes son lograr una presión arterial sistólica < 130 mm Hg y diastólica < 80 mm Hg, y menores en el paciente proteinúrico (< 125/75 mm Hg). Para alcanzar estos objetivos debe restringirse la ingesta de sodio a < 2 000 mg/día, considerándose los inhibidores del sistema renina angiotensina como las drogas de elección inicial para retrasar la disminución del filtrado glomerular. El algoritmo del tratamiento antihipertensivo sugiere la modificación de los hábitos de vida y asociaciones farmacológicas orientadas fisiopatológicamente para alcanzar los objetivos.

Palabras clave
hipertensión, nefropatía diabética, insuficiencia renal crónica


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Abstract
Diabetes mellitus affects approximately 10% of the adult population. Diabetic nephropathy is the main etiology of end stage renal disease. Hypertension is extremely frequent among type 2 diabetes patients, being diagnosed prior to, simultaneously with or after diabetes itself. Among type 1 diabetes patients hypertension is generally a consequence of diabetic nephropathy. Hypertension is a principal risk factor for cardiovascular disease and for nephropathy progression, while its treatment prevents cardiovascular and renal events. Pathophysiology of hypertension and nephropathy in diabetes involves increased sodium reabsorption and vasoconstriction mediated by upregulation of the renin angiotensin aldosterone system and imbalanced modulators of vascular tone. The general targets for hypertension treatment in diabetes patients are systolic < 130 mm Hg and diastolic < 80 mm Hg, which should be lower in proteinuric patients (< 125/75 mm Hg). To reach these targets patients should restrict dietary sodium to < 2 000 mg/day. First line drugs are the inhibitors of the renin angiotensin aldosterone system, because multiple studies showed they could delay renal disease progression. The algorithm for hypertension treatment in advanced diabetes nephropathy involves lifestyle counseling and multiple drug regimens which should be pathophysiologically oriented.

Key words
hypertension, diabetic nephropathy, chronic kidney disease


Clasificación en siicsalud
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página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Cardiología, Nefrología y Medio Interno
Relacionadas: Atención Primaria, Diabetología, Endocrinología y Metabolismo, Geriatría, Medicina Familiar, Medicina Interna



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Enviar correspondencia a:
Alfredo Wassermann, FEPREVA Fundación para el Estudio, la Prevención y el Tratamiento de la Enfermedad Vascular Aterosclerótica , 1429, Núñez 2602, 1° A, Buenos Aires, Argentina
Bibliografía del artículo
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