Este documento presenta información sobre el uso de antihipertensivos en pacientes con enfermedad renal crónica (IRC). Describe las diferentes clases de antihipertensivos incluyendo bloqueadores de canales de calcio, inhibidores de la enzima convertidora de angiotensina, bloqueadores del receptor de angiotensina II y agonistas alfa centrales. Resalta que estos medicamentos pueden usarse de manera segura en pacientes con IRC pero algunos requieren ajustes de dosis debido a su metabolismo o eliminación. También discute ensay

1. USO DE ANTIHIPERTENSIVOS EN IRC MC EDILBERTO IBAÑEZ BURGOS SERVICIO DE NEFROLOGIA HNAAA CHICLAYO-PERU

4. Adapted from JNC VII or >100 >160 Stage 2 hypertension or 90-99 140-159 Stage 1 hypertension or 80-89 120-139 Prehypertension and <80 <120 Normal Diastolic BP, mm Hg Systolic BP, mm Hg Classification of Blood Pressure (JNC VII)

5. DASH = Dietary Approaches to Stop Hypertension Adapted from JNC VII 2-4 mm Hg Limit consumption to no more than 2 drinks per day in most men and no more than 1 drink per day in women and in lighter weight persons. Moderation of alcohol consumption 4-9 mm Hg (at least 30 minutes/day, most days of the week) Physical activity 2-8 mm Hg (2.4 g sodium or 6 g sodium chloride) Dietary sodium reduction 8-14 mm Hg fruits, vegetables, and dairy products with a reduced content of saturated and total fat (K,Ca) Adopt DASH eating plan 5-20 mm Hg/ 10 kg weight loss IMC:18.4-24.9 kg/m 2 Weight reduction Approximate SBP Reduction Range Recommendation Modification LIFESTYLE MODIFICATIONS TO MANAGE HYPERTENSION *†

6. PROGRESS X X RECURRENT STROKE PREVENTION NKF GUIDELINE, CAPTOPRIL TRIAL, RENAAL, IDNT, REIN, AASK X X CHRONIC KIDNEY DISEASE NKF-ADA Guideline, UKPDS, ALLHAT X X X X X DIABETES ALLHAT, HOPE, ANBP2, LIFE, CONVINCE X X X X HIGH CORONARY DISEASE RISK ACC/AHA Post-MI Guideline, BHAT, SAVE, Capricorn, EPHESUS X X X POSTMYOCARDIAL INFARCTION ACC/AHA Heart Failure Guideline, MERIT-HF, COPERNICUS, CIBIS, SOLVD, AIRE, TRACE, ValHEFT, RALES X X X X X HEART FAILURE AANT BCC ARA IECA BB D Clinical Trial Basis ‡ Recommended Drugs † Compelling Indication* Clinical Trial and Guideline Basis for Compelling Indications for Individual Drug Classes

29. ß-Adrenergic Blockers: * Medications are listed is alphabetical, not preferential order. carvedilol, labetalol Nonselective ß- and α- antagonists acebutolol ß 1 -selective with partial agonist activity atenolol, betaxolol, bisoprolol, metoprolol ß 1 -selective carteolol, penbutolol, pindolol Nonselective with partial agonist activity nadolol, propranolol, timolol Nonselective ß-adrenergic blockers Medication* Drug Class ß-Adrenergic Blockers

39. Calcium Channel Blockers:

44. Calcium Channel Blockers

59. Angiotensin-Converting Enzyme Inhibitors

62. Angiotensin II Receptor Blockers

77. Central α2-Agonists

90. GRACIAS