Article

Tratamento da Hipertensão Arterial Sistêmica Resistente

Procardiol 01/2011; 6:63-96.

ABSTRACT Leopoldo F. Saldanha, Aurélio Rotolo da Costa Araújo. Tratamento da Hipertensão Arterial Sistêmica resistente. Introdução. O objetivo do tratamento do paciente com hipertensão arterial sistêmica (HAS) é reduzir o risco cardio-vascular associado com a elevação da pressão arterial (PA). 1-3 A mortalidade por doença cardiovascular aumenta progressivamente, de forma linear, contínua e independente, em ambos os sexos e em todas as faixas etárias, com a elevação da PA a partir de 115/75mm Hg. 2,4 De acordo com diversas diretrizes, 5-7 inclusive a VI Diretrizes Brasileiras de Hipertensão, 8 as metas a serem obtidas no tratamento da HAS no adulto devem estar baseadas em características individuais e conforme o método empregado para aferição da PA. Pacientes com hipertensão arterial resistente (HAR) são aqueles cujas metas de PA não são atingidas, apesar do uso de três agentes anti-hipertensivos de diferentes classes, inclusive um diurético, ou cujas metas da PA somente são atingidas com o uso de quatro ou mais anti-hipertensivos. Quando se avalia a HAR, é importante afastar a possibilidade de pseudorresistência, resultante de fatores como medida inadequada da PA, efeito do avental branco e não adesão ao tratamento. Fatores contribuintes devem ser identificados e revertidos, incluindo obesidade, excesso de consumo de álcool e uso de subs-tâncias que interferem no controle da PA, especialmente anti-inflamatórios não hormonais (AINH), agentes simpaticomiméticos e estimulantes, além de anticoncepcionais.

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