BOLETÍN HTA

HIPERTENSIÓN / 2018 / VOL. 23 61 Conclusiones Tal como se planteó al inicio, no hay consenso en las metas de PA que deben alcanzar los pacientes con ERC como objetivo terapéutico. La tendencia es llegar a valores bajo el punto de corte, con valores de PAS cercanas a 130 mmHg. Hechos que se repiten: • Uso de bloqueo del sistema renina-angiotensina como primera línea en pacientes con ERC, con o sin proteinuria. • No es recomendable el doble bloqueo del sistema renina-angiotensina. • Terapia personalizada, para evaluar los cambios en electrolitos (sodio y potasio) y filtrado glomerular. La cautela y dedicación al enfermo resultarán, igual que en todo proceso médico, en el mejor resultado para el paciente. Referencias 1. Van den Hoogen PC, Feskens EJ, Nagelkerke The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. NJ et al. N Engl J Med 2000; 342: 1–8. 2. Kidney Disease Outcomes Quality Initiative. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004; 43: S1–290 3. Plantinga LC, Miller ER, III, Stevens LA et al. Blood pressure control among persons without and with chronic kidney disease: US trends and risk factors. 1999–2006. Hypertension 2009; 54: 47–56 4. James PA, Oparil S, Carter BL et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507–520 5. Sarnak MJ, Levey AS, Schoolwerth AC, et al Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research,Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003; 108:2154–2169. 6. Bidani AK, Griffin KA, Williamson G, et al. Protective importance of the myogenic response in the renal circulation. Hypertension. 2009; 54:393–398. 7. Rakesh Malhotra, MD, MPH; Hoang Anh Nguyen, MD, MPH; Oscar Benavente, MD et al ; Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 5 A Systematic Review and Meta-analysis JAMA Intern Med. 2017;177(10):1498-1505. 8. Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes: UKPDS 40. UK Prospective Diabetes Study Group. BMJ. 1998; 317(7160):720–726. 9. Cushman W.C., Evans G.W., Byington R.P. et al. ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010; 362:1575–1585. 10. Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med. 2005; 142(5):342–351 11. Pastor-Barriuso R, Banegas JR, Damian J, . Systolic blood pressure, diastolic blood pressure, and pulse pressure: an evaluation of their joint effect on mortality. Ann Intern Med. 2003; 139(9):731–739. 12. Alfred K. Cheung, Mahboob Rahman, David M. Reboussin, Effects of Intensive BP Control in CKD, J Am Soc Nephrol 28: 2812–2823, 2017. 13. De Nicola L, Borrelli S, Gabbai FB, et al. Burden of resistant hypertension in hypertensive patients with non-dialysis chronic kidney disease. Kidney Blood Press Res. 2011; 34(1):58–67. 14. Bangash F, Agarwal R. Masked hypertension and white-coat hypertension in chronic kidney disease: a meta-analysis. Clin J Am Soc Nephrol. 2009; 4(3):656–64. 15. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Paul K. Whelton, MB, MD, MSc, FAHA, Chair; Robert M. Carey, MD, FAHA, Vice Chair; Wilbert S. Aronow, MD, FACC, FAHA*; Hypertension. 2018; 71:1269-1324. 16. Parving HH, Brenner BM, McMurray JJ, et al, ALTITUDE Investigators. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 2012; 367:2204–2213. 17. 2018 ESC/ESH Guidelines for themanagement of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Authors/Task Force Members: Bryan Williams* (ESC Chairperson) (UK), Giuseppe Mancia* (ESH Chairperson) (Italy), Wilko Spiering (The Netherlands), Enrico Agabiti Rosei (Italy), European Heart Journal (2018) 39, 3021–3104.