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8 Recomendaciones
Eder Luna Cern EMIS 4
Recomendacin 1: Recurrir a Tx farmacolgico cuando el paciente mayor de 60 aos tenga una presin mayor a
150/90. Meta: Menor a 150/90. En el mismo segmento de poblacin, si la TA se reduce ms de la meta, no ajustar
la dosis si es que no tienen efectos adversos importantes.
Recomendacin 2: En pacientes menores a 60 aos, dar tratamiento farmacolgico cuando la presin distolica
exceda el umbral de 90mmHg y tener una meta de menor a 90mmHg. Bajar la presin ms abajo no correlaciona
con mejores resultados.
Recomendacin 3: En personas menores a 60 aos, comenzar tratamiento farmacolgico con una presin sistlica
de 140, teniendo como meta menos de 140mmHg.
Recomendacin 4: En personas con edad igual o mayor a 18 aos con enfermedad renal crnica iniciar tratamiento
con una presin de 140/90 y llegar a la meta de menor a 140/90.
Recomendacin 5: En personas personas con edad igual o mayor a 18 aos con diabetes iniciar tratamiento con
una presin de 140/90 y llegar a la meta de menor a 140/90.
Recomendacin 6: En la poblacin blanca aun con diabetes iniciar tratamiento con diurticos tiazdicos,
bloqueadores de calcio, IECAS, ARB.
Recomendacin 7: En la poblacin negra aun con diabetes iniciar tratamiento con diurticos tiazdicos o
bloqueadores de calcio.
Recomendacin 8: En personas con enfermedad renal crnica mayores 18 aos, incluso con diabetes o cualquier
raza iniciar o aadir al Tx IECAS y ARB.
Recomendacin 9: El principal objetivo es mantener y reducir la TA. SI la TA meta no se alcanza en un mes de Tx
aumentar dosis del tratamiento inicial o aadir otro medicamento de los recomendados en la recomendacin 6. Si
no se consigue la meta con 2 frmacos aadir un tercero. Si no se puede, aadir otro ms, si no es posible aadir
otro debido a interacciones, entonces elegir uno fuera de la lista de la reomendacin 6.


Clinical Review & Education Special Communication

2014 Guideline for Management of High Blood Pressure

Figure. 2014 Hypertension Guideline Management Algorithm


Adult aged 18 years with hypertension

Implement lifestyle interventions


(continue throughout management).
Set blood pressure goal and initiate blood pressure lowering-medication
based on age, diabetes, and chronic kidney disease (CKD).
General population
(no diabetes or CKD)

Age 60 years

Blood pressure goal


SBP <150 mm Hg
DBP <90 mm Hg

Diabetes or CKD present

Age <60 years

All ages
Diabetes present
No CKD

All ages
CKD present with
or without diabetes

Blood pressure goal


SBP <140 mm Hg
DBP <90 mm Hg

Blood pressure goal


SBP <140 mm Hg
DBP <90 mm Hg

Blood pressure goal


SBP <140 mm Hg
DBP <90 mm Hg

Nonblack

Black

Initiate thiazide-type diuretic


or ACEI or ARB or CCB, alone
or in combination.a

All races

Initiate thiazide-type diuretic


or CCB, alone
or in combination.

Initiate ACEI or ARB, alone


or in combination with other
drug class.a

Select a drug treatment titration strategy


A. Maximize first medication before adding second or
B. Add second medication before reaching maximum dose of first medication or
C. Start with 2 medication classes separately or as fixed-dose combination.

At goal blood pressure?

Yes

No
Reinforce medication and lifestyle adherence.
For strategies A and B, add and titrate thiazide-type diuretic or ACEI or ARB or CCB (use
medication class not previously selected and avoid combined use of ACEI and ARB).
For strategy C, titrate doses of initial medications to maximum.

At goal blood pressure?

Yes

No
Reinforce medication and lifestyle adherence.
Add and titrate thiazide-type diuretic or ACEI or ARB or CCB (use medication class
not previously selected and avoid combined use of ACEI and ARB).

At goal blood pressure?

Yes

No
Reinforce medication and lifestyle adherence.
Add additional medication class (eg, -blocker, aldosterone antagonist, or others)
and/or refer to physician with expertise in hypertension management.
No

At goal blood pressure?

SBP indicates systolic blood pressure; DBP, diastolic blood pressure; ACEI,
angiotensin-converting enzyme; ARB, angiotensin receptor blocker; and CCB,
calcium channel blocker.

E10

a
b

Yes

Continue current
treatment and
monitoring.b

ACEIs and ARBs should not be used in combination.


If blood pressure fails to be maintained at goal, reenter the algorithm where
appropriate based on the current individual therapeutic plan.

JAMA Published online December 18, 2013

Copyright 2013 American Medical Association. All rights reserved.

jama.com