2017, Número 3
<< Anterior
Arch Med Fam 2017; 19 (3)
Hipertensión arterial en el paciente obeso
Rubio GAF, Narváez RJL
Idioma: Español
Referencias bibliográficas: 39
Paginas: 69-80
Archivo PDF: 158.87 Kb.
RESUMEN
La hipertensión arterial y la obesidad suelen coexistir en el mismo paciente, la asociación aumenta significativamente el riesgo de diabetes mellitus, cardiopatía isquémica e insuficiencia cardiaca. El control adecuado de la tensión arterial en el paciente obeso es prioritario para prevenir complicaciones cardiovasculares y renales. Se recomienda iniciar tratamiento farmacológico con inhibidores del eje renina angiotensina para reducir el riesgo de progresión a diabetes. Sin embargo, la mayoría de los pacientes van a requerir combinaciones de agentes para su control. En este escrito se revisan conceptos actuales en la fisio-patología de la hipertensión en el sujeto obeso y actualidades en su manejo.
REFERENCIAS (EN ESTE ARTÍCULO)
Barquera S, Campos-Nonato I, Hernández-Barrera L, Pedroza A, Rivera-Dommarco JA. Prevalencia de obesidad en adultos mexicanos, 2000-2012. Salud Pública Méx 2013;55 supl.2:S151-S160.
Arena R, Daugherty J, Bond S, Lavie CJ, Phillips S, Borghi-Silva A. The combination of obesity and hypertension: a highly unfavorable phenotype requiring attention. Curr Opin Cardiol. 2016;31:394-401.
Rubio AF. Hipertensión arterial en el paciente obeso. En: Pliego C, Rubio A. Temas Selectos de Medicina Interna 2008. México. Alfil. 2008. p. 129-138.
Jordan J, Birkenfeld AL. Cardiometabolic crosstalk in obesity-associated arterial hypertension. Rev Endocr Metab Disord 2016;17:19-28.
Rubio AF. Vargas G. Hipertensión resistente. En Cabrera A. Halabe J. Temas Selectos de Medicina Interna 2007; México. Alfil 2007:113-118.
Boustany CM, Bharadwaj K. Daugherty A. Brown Dr. Randall DC Cassis LA. Activation of the systemic and adipose renin-angiotensin system in rats with diet induced obesity and hypertension. Am J Physiol 2004;287:R943-R949.
Rubio-Guerra AF. Duran-Salgado MB. Insulina, sistema renina angiotensina aldosterona y disfunción endotelial. Rev Med IMSS 2011;49:581-584.
Cardillo C. Campia U. Iantorno M. Panza JA. Enhanced vascular activity of endogenous endothelin-1 in obese hypertensive patients. Hypertension 2004; 43:36-40.
Esler M. Straznicky N. Eikelis N. Masuo K. Lambert G. Lambert E. Mechanisms of sympathetic activation in obesity-related hypertension. Hypertension 2006;48:787-796.
Hall JE. Da Silva A. Brandon E. Stec DE. Ying Z. Jones DW. Pathophysiology of obesity-induced hypertension and target organ damage. In Lip GY. Hall JE. Comprehensive hypertension. Filadelfia, Mosby, 2007:447-468.
Rubio-Guerra AF, Morales-Lopez H, Garro-Almendaro AK y cols. Circulating levels of uric acid and risk for metabolic syndrome. Curr Diabetes Rev 2016;12: DOI:10.2174/1573399812666150930122507.
Blüher M. Adipokines – removing road blocks to obesity and diabetes therapy. Mol Metbolism 2014;2:230-240.
Rubio-Guerra AF, Duran-Salgado MB. Disfunción del tejido adiposo y síndrome metabólico. Sx Cardiometabólico Diabetes 2014;1:31-37.
Rubio-Guerra AF, Vargas-Robles H, Suárez-Cuenca JA, Lozano Nuevo JJ, Rodríguez-López L, Duran-Salgado MB, Escalante-Acosta BE. Concentraciones de adipocitocinas en pacientes diabéticos tipo 2, normotensos e hipertensos. Med Int Mex 2014;30:146-151.
Hall JE. Jones DW. Kuo JJ. Da Silva A. Liu J. Tallman L. Obesity and hypertension: Impact on cardiovascular and renal systems. In Oparil S. Weber MA. Hypertension. 2nd ed. Philadelphia. Elsevier. 2005. P.464-474.
Rubio-Guerra AF. De la Disfunción endotelial a la Clínica. Med.UIS 2013:26:51-57.
Madamanchi NR. Vendrov A. Runge MS. Oxidative Stress and vascular disease. Arterioscler Thromb Vasc Biol 2005;25:29-38.
Jordan J, Toplak H, Grassi G, Yumuk V, Kotsis V, Engeli S, Cuspidi C, Nilsson PM, Finer N, Doehner W. Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and heart failure. J Hypertens. 2016;34:1678-88.
Kambham N. Markowitz GS. Valeri AM. Obesity related glomerulopathy: An emerging epidemic. Kydney Int 2001;59:1498-1509.
Task Force for the management of arterial hypertension of the European Society of Hypertension; Task Force for the management of arterial hypertension of the European Society of Cardiology. 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension. Blood Press. 2013;22:193-278.
Rubio-Guerra AF, Rodríguez-López L, Lozano-Nuevo JJ, Vargas-Ayala G, Beltrán-Soto JM, Durán-Salgado MB. Prevalencia de tolerancia a la glucosa anormal en pacientes hipertensos. Rev Med Inst Mex Seguro Soc 2014; 52:404-407.
Rubio-Guerra AF, Durán-Salgado MB Perspectivas de la cirugía bariátrica. Sx Cardiometabólico Diabetes 2014;1:63-72.
Krause T, Lovibond K, Caulfield M, McCormack T, Williams B; Guideline Development Group. Management of hypertension: summary of NICE guidance. BMJ. 2011;343:d4891.
Blood Pressure Lowering Treatment Trialists' Collaboration, Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials. Lancet. 2015; 385(9971):867-74.
Rubio-Guerra AF. Castro-Serna D. Elizalde-Barrera CI. Ramos-Brizuela LM. Current concepts in combination therapy for the treatment of hypertension: combined calcium channel blockers and RAAS inhibitors. Integrated Blood Pressure Control 2009;2:55-862
Rubio AF. Lozano JJ. Vargas G. Rodríguez L. Ramos LM, Escalante B. Efficacy of a fixed-dose combination of trandolapril-verapamil in obese hypertensive patients resistant to monotherapy. Clin and Experiment Hypertens 2006;28:619-624.
Jamerson K, Weber MA, Bakris GL, Dahlof B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ. Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients. N Engl J Med 2008;359:2417-28.
Bakris GL. Molitch M. Hewkin A. y cols. Differences in glucose tolerance between fixed-dose antihypertensive drug combinations in people with metabolic syndrome. Diabetes Care 2006; 29:2592-2597.
Rubio-Guerra AF, Vargas-Robles H, Vargas-Ayala G, Rodríguez-Lopez L, Castro-Serna D, Escalante-Acosta BA. Impact of trandolapril therapy and its combination with a calcium channel blocker on plasma adiponectin levels in patients with type 2 diabetes and hypertension. Ther Adv Cardiovasc Dis. 2011;5:193-197.
Rubio-Guerra AF, Vargas-Robles H, Lozano-Nuevo JJ, Elizalde-Barrera CI, Huerta-Ramírez S, Escalante-Acosta BA. Beneficial effect of combination therapy with an angiotensin-converting enzyme inhibitor plus verapamil on circulating resistin levels in hypertensive patients with type-2 diabetes. Exp & Clin Cardiol 2012;17:202-204.
Durán-Salgado MB, Garro-Almendaro AK, Rubio-Guerra AF. Cambios metabólicos ocasionados por las combinaciones de losartán con hidroclorotiazida o con amlodipino en pacientes hipertensos. Med Int Mex 2015;31:395-401.
Jordan J, Stinkens R, Jax T, Engeli S, Blaak EE, May M, Havekes B, Schindler C, Albrecht D, Pal P, Heise T, Goossens GH, Langenickel TH. Improved Insulin Sensitivity with Angiotensin Receptor Neprilysin Inhibition in Individuals with Obesity and Hypertension. Clin Pharmacol Ther. 2016 Aug 20. doi: 10.1002/cpt.455. [Epub ahead of print]
Rubio AF. Medicina Alternativa e hipertensión arterial, En: Vargas G, Rodriguez L. Hipertensión arterial, casos especiales. México. Alfil. 2013. Pp. 313-18.
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA. 2007;297:842-857.
Stone NJ, Robinson JG, Lichtenstein AH, Goff DC Jr, Lloyd-Jones DM, Smith SC Jr, Blum C, Schwartz JS; 2013 ACC/AHA Cholesterol Guideline Panel. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Ann Intern Med. 2014;160:339-43.
Rubio-Guerra AF. Hipertensión arterial descontrolada en el paciente obeso. Lo que no debió pasar. Sx Cardiometabólico Diabetes 2014;1:51-54.
Larsen KS, Pottegård A, Lindegaard HM, Hallas J. Effect of Allopurinol on Cardiovascular Outcomes in Hyperuricemic Patients: A Cohort Study. Am J Med. 2016;129:299-306.
Tani S, Nagao K, Hirayama A. Effect of Febuxostat, a Xanthine Oxidase Inhibitor, on Cardiovascular Risk in Hyperuricemic Patients with Hypertension: A Prospective, Open-label, Pilot Study. Clin Drug Investig. 2015;35:823-31.
Rubio-Guerra AF, Garro-Almendaro AK, Elizalde-Barrera CI, Suarez-Cuenca JA, Duran-Salgado MB. Effect of losartan combined with amlodipine or with a thiazide on uric acid levels in hypertensive patients. Ther Adv Cardiovasc Dis. 2017;11:57-62.