33 Boletín Hipertensión VOL 25. 2021 / 27 - 33 Nefropatía hipertensiva se utilice IECA o ARA II, debe titularse la dosis hasta llegar a las máximas dosis recomendadas, siempre vigilando los cambios en el potasio y en la creatinina plasmática (21). En cambio, en la elección de las drogas de la 2 a línea, que corresponden a bloqueadores de los canales de calcio dihidripiridínicos (BCC-DHP), bloqueadores de los canales de calcio no dihidripiridínicos (BCC no-DHP), y beta bloqueadores (BB), dependerá de la frecuencia cardiaca y comorbilidades. Los BCC no-DHP tienen un efecto marginal en la reducción de la proteinuria. Así entonces, en la figura 3 se muestra una estrategia de control de la PA en la nefroesclerosis. Referencias 1. Segura J, Campo C, Gil P, et al. Development of chronic kidney disease and cardiovascular prognosis in essential hypertensive patients. J Am Soc Nephrol 2004;15:1616-22. 2. Freedman BI, Sedor JR. Hypertension-associated kidney disease: perhaps no more. J AmSoc Nephrol 2008;19:2047-51. 3. Marin R, Gorostidi M, Fernandez-Vega F, Alvarez-Navascues R. Systemic and glomerular hypertension and progression of chronic renal disease: the dilemma of nephrosclerosis. Kidney Int Suppl 2005:S52-6. 4. Perera GA. Hypertensive vascular disease; description and natural history. Journal of chronic diseases 1955;1:33-42. 5. Klag MJ, Whelton PK, Randall BL, et al. Blood pressure and end-stage renal disease in men. The New England journal of medicine 1996;334:13-8. 6. Ruilope LM, Salvetti A, Jamerson K, et al. Renal function and intensive lowering of blood pressure in hypertensive participants of the hypertension optimal treatment (HOT) study. J AmSoc Nephrol 2001;12:218-25. 7. Christiansen H, Segura J, Ruilope LM. Renal endpoints in hypertension trials. Clinical and experimental hypertension (New York, NY : 1993) 2004;26:721-6. 8. Rahman M, Ford CE, Cutler JA, et al. Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR. Clin J Am Soc Nephrol 2012;7:989-1002. 9. Bidani AK, Griffin KA. Pathophysiology of hypertensive renal damage: implications for therapy. Hypertension 2004;44:595-601. 10. Tagle R, Gonzalez F, Acevedo M. [Microalbuminuria and urinary albumin excretion in clinical practice]. Rev Med Chil 2012;140:797-805. 11. Tagle R, AcevedoM, Vidt DG. Microalbuminuria: is it a valid predictor of cardiovascular risk? Cleve Clin J Med 2003;70:255-61. 12. Bigazzi R, Bianchi S, Baldari D, Campese VM. Microalbuminuria predicts cardiovascular events and renal insufficiency in patients with essential hypertension. Journal of hypertension 1998;16:1325-33. 13. Cheung AK, Chang TI, CushmanWC, et al. Executive summary of the KDIGO 2021 Clinical Practice Guideline for theManagement of Blood Pressure in Chronic Kidney Disease. Kidney international 2021;99:559-69. 14. JohnsonRJ, Herrera-Acosta J, Schreiner GF, Rodriguez-IturbeB. Subtle acquired renal injury as a mechanism of salt-sensitive hypertension. The New England journal of medicine 2002;346:913-23. 15. Fernstrom A, Hylander B, Rossner S. Taste acuity in patients with chronic renal failure. Clin Nephrol 1996;45:169-74. 16. Conlin PR, Chow D, Miller ER, 3rd, et al. The effect of dietary patterns on blood pressure control in hypertensive patients: results from the Dietary Approaches to StopHypertension (DASH) trial. American journal of hypertension 2000;13:94955. 17. Levey AS, Greene T, Beck GJ, et al. Dietary protein restriction and the progression of chronic renal disease: what have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group. J Am Soc Nephrol 1999;10:2426-39. 18. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 2000;35:S1-140. 19. Alcohol and hypertension--implications formanagement. A consensus statement by the World Hypertension League. J HumHypertens 1991;5:227-32. 20. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 2006;47:296-308. 21. Nurko S. At what level of hyperkalemia or creatinine elevation should ACE inhibitor therapy be stopped or not started? Cleve Clin J Med 2001;68:754, 7-8, 60.
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