Hipertensão arterial sistêmica: atualidades sobre sua epidemiologia, diagnóstico e tratamento
Conteúdo do artigo principal
Resumo
A hipertensão arterial sistêmica é uma doença crônica com alta prevalência na população brasileira e mundial, com elevado custo econômico-social, principalmente em decorrência das suas complicações. Estima-se que exista cerca de 1 bilhão de indivíduos hipertensos no mundo, sendo a hipertensão arterial responsável por aproximadamente 7,1 milhões de óbitos por ano. Dando ênfase ao seu controle e tratamento precoces, a classificação da hipertensão arterial foi recentemente modificada pelo Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. A adoção de hábitos de vida saudáveis por todas as pessoas é essencial para a prevenção da hipertensão arterial, sendo indispensável como parte do tratamento para indivíduos hipertensos. A droga de escolha para a maioria dos pacientes portadores de hipertensão arterial primária é um diurético tiazídico. Foi realizado levantamento bibliográfico em bases de dados eletrônicos sobre o tema estudado em março de 2005. Das publicações encontradas, foram utilizadas as que apresentavam os maiores níveis de evidência. Devido a notável prevalência da hipertensão arterial em nosso meio e da necessidade de uma abordagem correta desses pacientes pelos profissionais de saúde, tivemos como objetivo sistematizar o conhecimento atual sobre aspectos epidemiológicos, diagnósticos e terapêuticos da hipertensão arterial.
Downloads
Detalhes do artigo
Referências
Chobanian AV, Bakris GL, Black HR et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension 2003;42(6):1206-52.
Burt VL, Whelton P, Roccella EJ et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995;25(3):305-13. http://dx.doi.org/10.1161/01.HYP.25.3.305
Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA 2003;290(2):199-206. http://dx.doi.org/10.1001/jama.290.2.199
Mion D Jr, Gomes MA, Fernando N e col. IV Diretrizes Brasileiras de Hipertensão Arterial. Arq Bras Cardiol. 2004;82(supl 4):1-14.
Vasan RS, Beiser A, Seshadri S et al. Residual lifetime risk for developing hypertension in middle-aged women and men: the framingham heart study. JAMA 2002;287(8):1003-10. http://dx.doi.org/10.1001/jama.287.8.1003
Wilson PW. Established risk factors and coronary artery disease: the framingham study. Am J Hypertens 1994;7(7 Pt 2):7S-12S.
Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA 1996;275(20):1557-62. http://dx.doi.org/10.1001/jama.1996.03530440037034
Coresh J, Wei GL, McQuillan G et al. Prevalence of high blood pressure and elevated serum creatinine level in the United States. Findings from the third National Health and Nutrition Examination Survey (1988-1994). Arch Intern Med 2001;161(9):1207-16. http://dx.doi.org/10.1001/archinte.161.9.1207
Staessen JA, Wang J, Bianchi G, Birkenhager WH. Essential hypertension. Lancet 2003;361(9369):1629-41. http://dx.doi.org/10.1016/S0140-6736(03)13302-8
Pickering T. Recommendations for the use of home (self) and ambulatory blood pressure monitoring. American Society of Hypertension Ad Hoc Panel. Am J Hypertens 1996;9(1):1-11. http://dx.doi.org/10.1016/0895-7061(95)00341-X
Clement DL, De Buyzere ML, De Bacquer DA et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003;348(24):2407-15. http://dx.doi.org/10.1056/NEJMoa022273
Neal B, MacMahon S, Chapman N. Blood pressure lowering treatment trialist's collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet 2000;356(9246):1955-64.
Ogden LG, He J, Lydick E, Whelton PK. Long-term absolute benefit of lowering blood pressure in hypertensive patients according to the JNC VI risk stratification. Hypertension 2000;35(2):539-43. http://dx.doi.org/10.1161/01.HYP.35.2.539
Whelton PK, He J, Appel LJ et al. Primary prevention of hypertension: Clinical and public health advisory from The National High Blood Pressure Education Program JAMA 2002;288(15):1882-8.
Appel LJ, Champagne CM, Harsha DW et al. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Writing Group of the PREMIER Collaborative Research Group. JAMA 2003;289(16):2083-93.
He J, Whelton PK, Appel LJ, Charleston J, Klag MJ. Longterm effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension 2000;35(2):544-9. http://dx.doi.org/10.1161/01.HYP.35.2.544
Sacks FM, Svetkey LP, Vollmer WM et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASHSodium Collaborative Research Group. N Engl J Med 2001;344(1):3-10. http://dx.doi.org/10.1056/NEJM200101043440101
Vollmer WM, Sacks FM, Ard J et al. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2001;38:1112-7. http://dx.doi.org/10.1161/hy1101.093424
Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002;136(7):493-503. http://dx.doi.org/10.7326/0003-4819-136-7-200204020-00006
Hunt SA, Baker DW, Chin MH et al. ACC/AHA Guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the International Society for Heart and Lung Transplantation; endorsed by the Heart Failure Society of America. Circulation 2001;104(24):2996-07.
Tepper D. Frontiers in congestive heart failure: effect of Metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). MERIT-HF Study Group. Congest Heart Fail 1999; 5(4):184-5.
Packer M, Coats AJ, Fowler MB et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001;344(22):1651-8.
CIBIS Investigators and Committees. A randomized trial of betablockade in heart failure. The Cardiac Insufficiency Bisoprolol Study (CIBIS). Circulation 1994;90(4):1765-73.
The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325(5):293-02.
The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993;342(8875):821-8.
Kober L, Torp-Pedersen C, Carlsen JE et al. A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. N Engl J Med 1995;333(25):1670-6. http://dx.doi.org/10.1056/NEJM199512213332503
Cohn JN, Tognoni G, The Valsartan Heart Failure Trial Investigators. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001;345(23):1667-75. http://dx.doi.org/10.1056/NEJMoa010713
Pitt B, Zannad F, Remme WJ et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999;341(10):709-17. http://dx.doi.org/10.1056/NEJM199909023411001
McMurray J, Ostergren J, Pfeffer M et al. Clinical features and contemporary management of patients with low and preserved ejection fraction heart failure: baseline characteristics of patients in the Candesartan in Heart failure-Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur J Heart Fail 2003;5(3):261-70. http://dx.doi.org/10.1016/S1388-9842(03)00052-7
Gibbons RJ, Abrams J, Chatterjee K et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina–summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 2003;41(1):159-68. http://dx.doi.org/10.1016/S0735-1097(02)02848-6
Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. I. Mortality results. JAMA 1982;247(12):1707-14. http://dx.doi.org/10.1001/jama.1982.03320370021023
Pfeffer MA, Braunwald E, Moye LA et al. Effect of captopril on mortality and morbidity in patients with left 1246 Hypertension December 2003 ventricular dysfunction after myocardial infarction. Results of the Survival and Ventricular Enlargement trial. The SAVE Investigators. N Engl J Med 1992;327(10):669-77. http://dx.doi.org/10.1056/NEJM199209033271001
Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: The CAPRICORN randomised trial. Lancet 2001;357(9266):1385-90. http://dx.doi.org/10.1016/S0140-6736(00)04560-8
Pitt B, Remme W, Zannad F et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348(14):1309-21. http://dx.doi.org/10.1056/NEJMoa030207
Black HR, Elliott WJ, Grandits G et al. Principal results of the Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE) trial. JAMA 2003;289(16):2073-82. http://dx.doi.org/10.1001/jama.289.16.2073
Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbidity and mortality in the Losartan intervention for endpoint reduction in hypertension study (LIFE): A randomized trial against atenolol. Lancet 2002;359(9311):995-1003. http://dx.doi.org/10.1016/S0140-6736(02)08089-3
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in highrisk hypertensive patients randomized to angiotensinconverting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288(23):2981-97. http://dx.doi.org/10.1001/jama.288.23.2981
Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Hearts Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342(3):145-53. http://dx.doi.org/10.1056/NEJM200001203420301
Wing LM, Reid CM, Ryan P et al. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003;348(7):583-92. http://dx.doi.org/10.1056/NEJMoa021716
Fox KM, European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003;362(9386):782-8. http://dx.doi.org/10.1016/S0140-6736(03)14286-9
Pepine CJ, Handberg EM, Cooper-DeHoff RM et al. A calcium antagonist versus a noncalcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil- Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003;290:2805-16. http://dx.doi.org/10.1001/jama.290.21.2805
Arauz-Pacheco C, Parrott MA, Raskin P. American Diabetes Association. Treatment of hypertension in adults with diabetes. Diabetes Care 2003;26(Suppl 1):S80-2. http://dx.doi.org/10.2337/diacare.26.2007.S80
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1): S1-266. http://dx.doi.org/10.1016/S0272-6386(02)70132-7
Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. UK Prospective Diabetes Study Group. BMJ 1998;317(7160):713-20. http://dx.doi.org/10.1136/bmj.317.7160.713
Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin- converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med 1993;329(20):1456-62. http://dx.doi.org/10.1056/NEJM199311113292004
Brenner BM, Cooper ME, de Zeeuw D et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001;345(12):861-9. http://dx.doi.org/10.1056/NEJMoa011161
Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001;345(12):851-60. http://dx.doi.org/10.1056/NEJMoa011303
The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997;349(9069):1857-63. http://dx.doi.org/10.1016/S0140-6736(96)11445-8
Wright JT Jr, Agodoa L, Contreras G et al. Successful blood pressure control in the African American Study of Kidney Disease and Hypertension. Arch Intern Med 2002;162(14):1636-43. http://dx.doi.org/10.1001/archinte.162.14.1636
Progress Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001;358:1033-41. http://dx.doi.org/10.1016/S0140-6736(01)06178-5
Hansson L, Lindholm LH, Ekbom T et al. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity: the Swedish Trial in Old Patients with Hypertension-2 Study. Lancet 1999;354(9192):1751-6. http://dx.doi.org/10.1016/S0140-6736(99)10327-1
Gueyffier F, Bulpitt C, Boissel JP et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. Indiana Group. Lancet 1999;353(9155):793-6. http://dx.doi.org/10.1016/S0140-6736(98)08127-6