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REPBLICA BOLIVARIANA DE VENEZUELAINSTITUTO UNIVERSITARIO DE TECNOLOGA

JUAN PABLO PREZ ALFONZOIUTEPALEXT: MARACAY

HIPERTENSINARTERIAL

PROFESOR: ALUMNALUIS HERNNDEZ ARIAS DAYANAC.I: 12.573.189

SECCIN: 204F

FEBRERO! 20"#

INTRODUCCINHipertensin !rteri!" es "! e"e#!$in s%steni&! &e "%s ni#e"es &e "! presin

s!n'()ne! p%r en$i*! &e #!"%res $%nsi&er!&%s. En 'ener!" "! en+er*e&!& es

!sint%*,ti$! es &e$ir n% pr%&($e nin'(n! *%"esti! en e" p!$iente- ! pes!r &e tener

*($!s #e$es *(/ !"t!s s(s $i+r!s tensi%n!"es. Es p%r e""% 0(e se "e ""!*! e" ene*i'%

si"en$i%s% /! 0(e "! !(sen$i! &e s)nt%*!s n% %"i'! ! !$(&ir ! $%ns("t!. A"'(n%s

p!$ientes p(e&en re+erir &%"%r en "! p!rte p%steri%r &e s( $!e! ! pre&%*ini%

*!t(tin% 0(e in$"(s% en %p%rt(ni&!&es- p(e&e &espert!r"%. tr%s p(e&en re+erir

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*!re%s per% en 'ener!" n% !/ (n! sint%*!t%"%')! espe$)+i$! pr%&($i&! p%r "!

en+er*e&!&.

A *e&i&! 0(e pr%'res! "! en+er*e&!& #! pr%&($ien&% &!4%s ! ni#e" &e "%sr'!n%s "!n$%s / !s) #e*%s 0(e en e" $%r!n pr%&($e !(*ent% &e" 'r%s%r &e "!

p!re& &e" #entr)$("% i0(ier&% $%n "% $(!" !(*ent! e" ries'% &e s(+rir in+!rt%s &e

*i%$!r&i% / !n'in! &e pe$% 0(e ! s( #e ""e#! ! &i"!t!$in $!r&)!$! $%n ins(+i$ien$i!

$!r&)!$! / *(erte.E" ri4n t!*in s(+re &!4%s p%r "! H6A /! 0(e pr%&($e "! pr&i&! &e

pr%te)n!s 0(e ini$i!"*ente se ""!*! *i$r%!"(*in(ri! "% $(!" pr%'res! !st! ""e'!r !

ins(+i$ien$i! ren!" 0(e re0(iere &i,"isis / est% t!*in ""e#! ! "! *(erte &e" p!$iente.

A ni#e" $erer!" "! ipertensin !rteri!" n% $%ntr%"!&! !"ter! "! $ir$("!$in / se

*!ni+iest! $%*% !t!0(es $erer%#!s$("!res is0(*i$%s p%r +!"t! &e ""e'!&! &e s!n're

%i'en!&! !" tei&% $erer!" % e*%rr,'i$%s p%r "! r(pt(r! &e !"'(n! !rteri!. L!s

$%nse$(en$i!s se tr!&($en en se#er! &is$!p!$i&!& &e" p!$iente 0(e s%re#i#e ! est%s

e#ent%s / pr%!"e*ente 0(e&!n &epen&ientes &e "! +!*i"i! p%r n% p%&er #%"#er !

"!%r!r. En "!s !rteri!s &e" ipertens% %$(rre (n pr%$es% 0(e se ""!*! re*%&e"!&%

#!s$("!r 0(e $%nsiste en 0(e "! $!p! *(s$("!r &e" #!s% !(*ent! &e 'r%s%r / est%

!'r!#! e" &!4% ! t%&%s "%s r'!n%s $%rp%r!"es. L%s %%s s(+ren "%s e+e$t%s &e "! H6A/! 0(e en "! retin! "%s #!s%s se !"ter!n / pr%&($en "! retin%p!t)! ipertensi#! 0(e #!

&es&e e" 'r!&% 1 !" ;. Este &!4% retini!n% p(e&e ""e#!r ! "! pr&i&! &e "! #isin.

HIPERTENSIN ARTERIAL$U ES%

L! presin !rteri!" es "! +(er! ne$es!ri! p!r! 0(e "! s!n're $ir$("e ! tr!#s &e

"%s #!s%s !rteri!"es. C(!n&% est! +(er! es e$esi#! % *,s !"t! &e "% re$%*en&!"e- se

!"! &e ipertensin !rteri!" H6A. Se &i$e 0(e "! tensin !rteri!" es !"t! $(!n&%

s(per! "!s $i+r!s &e 1;e" !sesin% si"en$i%s%>- p%r0(e en "! *!/%r)! &e $!s%s n% present!

s)nt%*!s- p%r "% 0(e se p(e&en ""e'!r ! &es!rr%""!r pr%"e*!s $!r&i!$%s % ren!"es sin

ser $%ns$ientes &e p!&e$er ipertensin.

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&ISTOLOGA DE LA &IPERTENSIN ARTERIAL

?!r! +ines &e" si'"% @I@ / prin$ipi%s &e" si'"% @@ !p!re$e "! &en%*in!&!tr!nsi$in epi&e*i%"'i$!- 0(e $%nsiste en 0(e "!s en+er*e&!&es in+e$$i%s!s- 0(e

*!t!!n en "! in+!n$i! % en "! (#ent(&- s%n s(stit(i&!s en 'r!n p!rte p%r "!s ""!*!&!s

en+er*e&!&es $rni$!s- 0(e *!t!n en "! e&!& !&("t! % en "! #ee. A" +in!" &e "! er!

in&(stri!"- *,s &e "!s &%s ter$er!s p!rtes &e "! *(erte s%n $!(s!&!s p%r e" $,n$er- "!s

en+er*e&!&es $!r&i%#!s$("!res / "%s !$$i&entes.C%*% p!rte &e "! tr!nsi$in epi&e*i%"'i$! est, e" !(*ent% pr%'resi#% &e "!s

en+er*e&!&es $!r&i%#!s$("!res. !% est! &en%*in!$in se en'"%!n *($!s

en+er*e&!&es 0(e !+e$t!n t!nt% !" $%r!n $%*% ! "%s #!s%s s!n'()ne%s. Sine*!r'%- p!r! e+e$t%s pr,$ti$%s / $%*% $!(s!ntes &e *,s &e" 5

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"! *,s 'r!n&e epi&e*i! *(n&i!" e" $re$i*ient% ep%nen$i!" &e est!s en+er*e&!&es

entre 19;< / 19F7.

A *e&i!&%s &e" si'"% @@- ! tr!#s &e *"tip"es est(&i%s epi&e*i%"'i$%s$%*% e" &e Gr!*in'!* en Est!&%s Uni&%s- entre 19;81978- se i&enti+i$!r%n

$"!r!*ente "%s prin$ip!"es +!$t%res &e ries'% p!r! "! en+er*e&!& $!r&i%#!s$("!r- t!"es

$%*% "! ipertensin !rteri!" n% $%ntr%"!&!- e" ,it% &e +(*!r- "! #i&! se&ent!ri!- "!

%esi&!&- "! iper"ipi&e*i! / ! pre&isp%si$in 'enti$!.C%*% res("t!&% &e est%s &es$(ri*ient%s se ini$i en *($%s p!)ses (n! 'r!n

$!*p!4! e&($!ti#! ten&iente ! &is*in(ir % e"i*in!r &i$%s +!$t%res &e ries'%. Es &e

!n%t!r t!*in e" en%r*e pr%'res% 0(e ! p!rtir &e 195< se &i% en e" &i!'nsti$% /

tr!t!*ient% &e "! en+er*e&!& $!r&i%#!s$("!r- ! tr!#s &e t$ni$!s $%*% "! !n'i%'r!+)!

$%n *e&i% &e $%ntr!ste- "! $ir(')! &e $%r!n !iert%- "! e$%$!r&i%'r!+)! / e"

&es$(ri*ient% &e *e&i$!*ent%s *,s e+e$ti#%s p!r! e" $%ntr%" &e "! ipertensin- 0(e

!n per*iti&% ! *i""%nes &e pers%n!s en t%&% e" *(n&% "ir!rse &e (n! *(erte

pre*!t(r!. L! *%rt!"i&!& *(n&i!" p%r en+er*e&!& #!s$("!r se en$(entr! en !"re&e&%r

&e" 5

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L! $!"i&!& &e "! s!n're#is$%si&!& E" $!"ire &e "! "(.

L! #e"%$i&!& &e "! s!n're $ir$("!n&%.E" prin$ip!" +!$t%r eti%"'i$% r!&i$! en e" t%n% &e "! p!re&. Se $%n%$en

i*p%rt!ntes +!$t%res 0(e in+"(/en en &i$% te*!- en e" senti&% &e !(*ent!r"%-

%ri'in!n&% (n! #!s%&i"!t!$in. Se4!"!*%s en $(!nt% ! est% "! iner#!$in #!s%*%t%r!-

es &e$ir- e" si*p,ti$% / e" p!r!si*p,ti$% Siste*!s !&renr'i$%s / $%"inr'i$%s.

C%*% e+e$t% "! #!s%$%nstri$$in- "! n%r!&ren!"in! / "! #!s%&i"!t!$in &e "!

A$eti"$%"in!. 6%&! est! iner#!$in #!s%*%t%r! se s(per#is! +(n&!*ent!"*ente ! "!

!$$in &e" $entr% #!s%*%t%r en e" ("%- e" $(!"- !" *is*% tie*p% re$ie in+"(en$i!s&i#ers!s: "! &e" $entr% respir!t%ri%- "! &e" sen% $!r%ti&e%- "! &e "%s ner#i%s !rti$%s /

%tr%s est)*("%s 0(i*i% / pres%rre$ept%res !rteri!"es / #en%s%s. Asi*is*% in+"(/e "!

tensin &e !n)&ri$% $!rni$% $ir$("!nte. 6!*in se "e &! i*p%rt!n$i! ! "! !$$in &e

$entr%s $%rti$!"es s(peri%res / &e" &ien$+!"% p!r! (n! (en! re'("!$in &e" $entr%

#!s%*%t%r.E" p!pe" &e" ri4n es sin &(&!s e" +!$t%r &e *!/%r i*p%rt!n$i! p!r! "!

#!"%r!$in eti%"'i$! &e "! H6A.En e" ri4n en $%n&i$i%nes espe$i!"es &e s( $ir$("!$in pr%pi! se p(e&e

pr%&($ir "! "ier!$in &e (n! s(st!n$i!Renin! 0(e p!s! ! "! s!n're / se $%*in! $%n

(n! '"%("in! $ir$("!nte e"!%r!&! p%r e" )'!&% ""!*!&! ipertensin'en%- !s) se

+%r*! (n! s(st!n$i! $%n%$i&! $%n e" n%*re An'i%stensin!ipertensin!. Ese +!$t%r

eti%"'i$% ren!" ! &%*in!&% / !n &%*in! en *($%s $!s%s $%*% $!(s! eti%"'i$!

+(n&!*ent!" en "!s ipertensi%nes- s%re t%&% &e "%s ne+r%'en%s- per% t!" $riteri%

eti%"'i$% n% p(e&e ser *!nteni&% p!r! t%&!s "!s ipertensi%nes.E" p!pe" &e" ri4n en *!nteni*ient% &e "! presin !rteri!" n%r*!" es e" &e

iniir (n siste*! +!$t%r pres%r- n% +%r*!&% en e" ri4n- sin%- +(er! &e "- se !"!&e (n! ipertensi&!s!.

tr%s +!$t%res "!n!r%n "! iptesis &e 0(e e" t!*!4% &e "%s ri4%nes s(

$!p!$i&!& +(n$i%n!" inter#ienen (n!s s(st!n$i!s ""!*!&!s ren%tr%+in!- "!s $(!"es !"

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est!r !(*ent!&!s en "! s!n're- &!n "('!r ! (n !(*ent% &e" t!*!4% / +(n$in &e"

ri4n.

SIGNOS Y SINTOMAS

D%"%r &e $!e! S(&%r!$i%nes ?("s% r,pi&% Respir!$in $%rt! !re% A"ter!$i%nes #is(!"es S%ni&% &e (*i&% en "%s %)&%s

R(%r +!$i!" !n$!s en "%s %%s $%*% %et%s %s$(r%s #%"!ntes.

CAUSAS DE LA &IPERTENSINL! 'r!n *!/%r)! &e "%s p!$ientes ipertens%s s%n &e $!(s! &es$%n%$i&! / se

""!*!n esen$i!"es. En 'ener!" tienen (n !nte$e&ente +!*i"i!r *!&re- p!&re % !(e"%s

ipertens%s / s%n ipertens%s pri*!ri%s en "%s $(!"es se !s(*e 0(e eiste (n! $!r'!

'enti$! i*p%rt!nte 0(e es "! 0(e ""e#! ! &es!rr%""!r "! en+er*e&!&. Sin e*!r'%eiste (n pe0(e4% p%r$ent!e &e p!$ientes en "%s $(!"es "! ipertensin es se$(n&!ri!

/ "!s prin$ip!"es $!(s!s 'ener!"*ente s%n &e %ri'en ren!"- ren%#!s$("!r- s(pr!rren!"-

et$. tr!s $!(s!s !n *en%s +re$(entes s%n *!"+%r*!$i%nes $%n'nit!s $%*% "!

$%!rt!$in &e "! !%rt!.

CONSECUENCIAS DE LA &IPERTENSINL! ipertensin n% tr!t!&! p(e&e pr%&($ir &i#ers%s &!4%s %r',ni$%s e"

&en%*in!&% &!4% &e "%s r'!n%s &i!n!. C%r!n- $erer%- ri4%nes- #!s%s s!n'()ne%s

/ %%s s%n p!rti$("!r*ente #("ner!"es.

COMPLICACIONES DE LA &IPERTENSIN ARTERIAL A'()'*+,-.)'+,*,

C(!n&% "%s #!s%s s!n'()ne%s se en$(entr!n s%*eti&%s ! (n !(*ent% &e

presin $%nst!nte- resp%n&en en'r%s!n&% s( p!re&- %$!si%n!n&% 0(e se!n *en%s

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+"ei"es. En est!s !rteri!s r)'i&!s se +i!n $%n +!$i"i&!& "!s 'r!s!s 0(e $ir$("!n en

e$es% en "! s!n're. A ni#e" &e "!s !rteri!s &e "%s ri4%nes- "! !rteri%s$"er%sis !$e 0(e

""e'(e *en%s +"(% !" ri4n- / "%s ri4%nes resp%n&en "ier!n&% renin!- (n! %r*%n!

0(e ! s( #e $!(s! (n !(*ent% &e "! tensin !rteri!". Est% e!'er! "! H6A / $!(s! !n

*,s &!4% s%re "%s #!s%s s!n'()ne%s.

C/'*+1/(/ &*1)'()3,*/C(!n&% "! !rteri%s$"er%sis !+e$t! ! "%s #!s%s en$!r'!&%s &e irri'!r !"

*i%$!r&i% "%s ""!*!&%s #!s%s $%r%n!ri%s- e" $%r!n se #e %"i'!&% ! re!"i!r (n

*!/%r es+(er% p!r! *!ntener e" +"(% s!n'()ne% en e" %r'!nis*%. En !"'(n%s $!s%s

"% !$e !(*ent!n&% &e t!*!4%- $%n (n! ipertr%+i! &e" *s$("% $!r&)!$%- !$in&%se*,s r)'i&% / *en%s e+i$!. E" res("t!&% +in!" p(e&e ser "! ins(+i$ien$i! $!r&)!$!

$%n'esti#!: e" %*e% &e s!n're p%r e" $%r!n n% es "% s(+i$iente*ente ne$es!ri%

p!r! *!ntener e" +"(% $ir$("!nte- / "%s ")0(i&%s se est!n$!n en t%&% e" %r'!nis*%.

E35)'6)/ ')3/.L! 0(int! p!rte &e "! s!n're %*e!&! p%r e" $%r!n est, &iri'i&! ! "%s

ri4%nes. Est%s se en$!r'!n &e +i"tr!r "%s pr%&($t%s &e &ese$% / !&e*,s *!ntienen "%s

#!"%res 0()*i$%s !&e$(!&%s. 6!*in $%ntr%"!n e" !"!n$e &e ,$i&%s- s!"es- / !'(!.L%s ri4%nes s%n espe$i!"*ente sensi"es ! "!s #!ri!$i%nes en e" +"(%

s!n'()ne% 0(e res("t!n &e "! H6A. N% p(e&en +(n$i%n!r ien si e" +"(% &is*in(/e-

!s) 0(e e" +"(% !% !$e 0(e se$reten *,s &e" eni*! renin!- 0(e !$e 0(e se

$%nstri4!n t%&!s "!s !rteri!s &e" $(erp%- s(ien&% "! tensin !rteri!" en (n intent% &e

rest!(r!r este +"(% ren!". Sin e*!r'%- en "ti*! inst!n$i!- "% 0(e se pr%&($e es (n

$)r$("% #i$i%s% 0(e ter*in! en *,s H6A / pe%r +(n$in ren!"- !st! ""e'!r !" +!""%

ren!".

A--*)3() -)')7'+/,-8./'C(!n&% "! !rteri%s$"er%sis !+e$t! ! "%s #!s%s &e" $erer%- p(e&e %$(rrir (n

"%0(e% &e s!n're ! !"'(n! p!rte &e" $erer% p%r (n! estre$e % (n $%,'("%

tr%*%sis $erer!"- % (n! r%t(r! &e (n #!s% e*%rr!'i! $erer!". 6%&% e""% es

*($% *,s +re$(ente en ipertens%s- / e" ries'% &is*in(/e !" tr!t!r "! H6A.

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TRATAMIENTO

C%*pren&e &%s tip%s: e" n% +!r*!$%"'i$% / e" tr!t!*ient% *e&i$!*ent%s%.T'/(/6*)3(+ N+ F/'6/-+.9*-+: C%nsiste en $!*i%s &e ,it%s &e #i&! &e"

p!$iente p!s!n&% &e ,it%s ins!"(res ! ,it%s s!"(&!"es / est%s in#%"($r!n:

A.*6)3(/-*93:Diet! DASH 0(e $%nsiste en re&($ir "! $!nti&!& &e s!" ! (n pr%*e&i%

&e 3 ! 5 'r!*%s &e s!" !" &)!- $%n !(*ent% &e "!s p%r$i%nes &e +r(t!s / #e'et!"es. Se

&ee re&($ir "! in'est! &e !"$%%" / &e !"i*ent%s $%nser#!&%s en"!t!&%s-

e*%te""!&%s- $!r$(ter)!s- 0(es%s *!&(r!&%s- et$. p%r s( !"t% $%nteni&% &e s%&i%.

Es i*p%rt!nte *!ntener e" pes% i&e!".

A-(**/ 5,*-/: se s('iere re!"i!r !"'n tip% &e eer$i$i% !eri$% $%*% s%n "!$!*in!t!- i$i$"et!- n!t!$in- &(r!nte 15< *in(t%s se*!n!"es es &e$ir re!"i!r 3