Seminario Taller Hipertensión Arterial Guía de Manejo JNC8

Presentación del tema: "Seminario Taller Hipertensión Arterial Guía de Manejo JNC8"— Transcripción de la presentación:

1 Seminario Taller Hipertensión Arterial Guía de Manejo JNC8
Salud Publica II Taller Manejo de la Hipertensión Arterial 16/11/2018

2 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. Published online December 18,2013.doi: /jama Taller Manejo de la Hipertensión Arterial 16/11/2018

3 Taller Manejo de la Hipertensión Arterial
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4 Editorial Assessing the Trustworthiness of the Guideline for Management of High Blood Pressure in Adults JAMA. 2013;():. doi: /jama Editorial Recommendations for Treating Hypertension:What Are the Right Goals and Purposes? Editorial Updated Guidelines for Management of High Blood Pressure:Recommendations, Review, and Responsibility Taller Manejo de la Hipertensión Arterial 16/11/2018

5 Guías Clínicas de Hipertension arterial ABSTRACT
Notas al pie Resumen JNC 8 Guías Clínicas de Hipertension arterial ABSTRACT  Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient. Hypertension remains one of the most important preventable contributors to disease and death. Abundant evidence from randomized controlled trials (RCTs) has shown benefit of antihypertensive drug treatment in reducing important health outcomes in persons with hypertension.1- 3 Clinical guidelines are at the intersection between research evidence and clinical actions that can improve patient outcomes. The Institute of Medicine Report Clinical Practice Guidelines We Can Trustoutlined a pathway to guideline development and is the approach that this panel aspired to in the creation of this report.4 The panel members appointed to the Eighth Joint National Committee (JNC 8) used rigorous evidence-based methods, developing Evidence Statements and recommendations for blood pressure (BP) treatment based on a systematic review of the literature to meet user needs, especially the needs of the primary care clinician. This report is an executive summary of the evidence and is designed to provide clear recommendations for all clinicians. Major differences from the previous JNC report are summarized in Table 1. The complete evidence summary and detailed description of the evidence review and methods are provided online (see Supplement). Taller Manejo de la Hipertensión Arterial 16/11/2018

6 Resumen This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults.  Umbrales para iniciartratamiento,objetivos y manejo con medicamentos, para la hipertension de la población adulta. Taller Manejo de la Hipertensión Arterial 16/11/2018

7 Evidencia. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; Tenemos fuerte evidencia para recomendar el tratamiento de pacientes hipertensión de 60 años o mayores, para lograr un control, cifra de 150/90 mmHg. Para hipertensos de 30 a 59 años de edad los valores de presion diastolica deben ser5 menores de 90mmHg. Taller Manejo de la Hipertensión Arterial 16/11/2018

8 Evidencia …however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion.  No hay suficiente evidencia para recomendar a pacientes hipertensos menores de 60 años , sus valores de presión sistólica, o en los más jóvenes , menores de 3o años sus valores de presión diastólica. El Panel de expertos recomienda : valores de PA menores de 140/90 para estos grupos. Taller Manejo de la Hipertensión Arterial 16/11/2018

9 Evidencia The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years.  Los mismos umbrales deben considerarse para hipertensos adultos con diabetes, o enfermedad renal no daibética, de manera análoga a la población hipertensa menor de 60 años. Taller Manejo de la Hipertensión Arterial 16/11/2018

10 Evidencia moderada existe para recomendar
Iniciar con un inhibidor de la ECA, Un bloqueador de los receptores de la ECA, un bloqueador de los canales de calcio, o un diurético tipo tiazidico en la población hipertensa no afroamericana, incluyendo los diabéticos. En los afro americanos incluyendo los diabéticos , se recomienda usar un calcio antagonista o un diurético tiazidico como tratamiento inicial. En los pacientes con enfermedad renal crónica, se sugiere agregar un inhibidor de la ECA, o un bloqueador de los receptores de la ECA, para mejorar los resultados esperados en el órgano blanco ( riñón). There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Taller Manejo de la Hipertensión Arterial 16/11/2018

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12 QUESTIONS GUIDING THE EVIDENCE REVIEW ¿ Tres preguntas ?
¿ El hecho de iniciar la terapia farmacológica antihipertensiva en adultos, en un umbral determinado , tiene consecuencias ( mejoría ) en los resultados de salud ?. ¿ Perseguir un objetivo con la terapia antihipertensiva farmacológica tiene como consecuencias mejoría en el estado de salud. ¿ En pacientes hipertensos adultos , los diferentes tratamientos con medicamentos de una u otra clase difieren en los beneficios y efectos dañinos para la salud ? In adults with hypertension, does initiating antihypertensive pharmacologic therapy at specific BP thresholds improve health outcomes? In adults with hypertension, does treatment with antihypertensive pharmacologic therapy to a specified BP goal lead to improvements in health outcomes? In adults with hypertension, do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes? Taller Manejo de la Hipertensión Arterial 16/11/2018

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15 Taller Manejo de la Hipertensión Arterial
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16 RESULTADOS (RECOMENDACIONES)
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17 RESULTADOS (RECOMENDACIONES)
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18 RESULTADOS (RECOMENDACIONES)
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21 Nicaragua, nuestra población de la Costa Atlántica
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22 Algoritmo de tratamiento de la Presión Arterial
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23 Algoritmo Manejo P.A. Taller Manejo de la Hipertensión Arterial
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24 Dosificación de los Medicamentos Antihipertensivos …Estrategia
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25 Copyright © 2014 American Medical Association. All rights reserved.
From: 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. 2013;():. doi: /jama Figure Legend: Guideline Comparisons of Goal BP and Initial Drug Therapy for Adults With Hypertension Date of download: 1/17/2014 Copyright © 2014 American Medical Association. All rights reserved.