Bloqueio sequencial do néfron em comparação com o bloqueio duplo do sistema renina angiotensina no tratamento da hipertensão arterial resistente

• Ano de defesa: 2018
• Autor(a) principal: Cestário, Elizabeth do Espírito Santo
• Orientador(a): Toledo, Juan Carlos Yugar
• Banca de defesa: Martin, Jose Fernando Vilela , Junior, Heitor Moreno , Pires, Antônio Carlos
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Faculdade de Medicina de São José do Rio Preto
• Programa de Pós-Graduação: Programa de Pós-Graduação em Ciências da Saúde::-6954410853678806574::500
• Departamento: Faculdade 1::Departamento 1::306626487509624506::500
• País: Brasil
• Palavras-chave em Português: Sistema Renina-Angiotensina; Hipertensão; Néfrons
• Palavras-chave em Inglês: Renin-Angiotensin System; Hypertension; Nephrons
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::8765449414823306929::600
• Link de acesso: http://bdtd.famerp.br/handle/tede/432

Resistant hypertension (RHT) is a clinical entity, difficult to manage. To identify the contribution of the volume as well as the renin activity from the maintenance of blood pressure levels could individualize the treatment. Objectives: To demonstrate the efficacy of therapy of sequential nephron blocking (SNB) in relation to the double blockade of the renin-angiotensin-aldosterone system associated with beta-blockers (DBRAS) in patients with RHT with > 85%-adherence rate after 20 weeks of treatment. Casuistic and Methods: A prospective study was conducted, open, randomized, parallel comparison between two regimens for RHT: SNB versus RAASDB. SNB consists in a progressive increase of sodium depletion with thiazide, followed by a blockade of mineralocorticoid receptor, followed by progressive doses of loop diuretics and finally blocking sodium channels. RAASDB consists in reinforcing the effect of angiotensin receptor blocker (ARB) with an angiotensin converting enzyme inhibitors (ACEI), followed by betablockers to decrease the renin secretion. Seventy two patients were randomized (35 to SNB 13M/22F and 37 to RAASDB14M/23F) coming from the tertiary outpatient clinic (HB-FAMERP). We used the criteria of VII Guidelines for Hypertension and V Guidelines for ABPM and HBPM SBC-SBH. The BP was monitored with the SpaceLabs 90207 ABPM using appropriate software of the equipment and issuing reports. Results: Baseline clinical characteristics and laboratory parameters of the 72 patients with primary resistant hypertension randomized to SNB (n=35) or RAASDB (n=37) were similar across both study groups. At the end of the study, a significant reduction of the office pressure was observed (SBP and DBP) in both postintervention groups (SNB group: initial SBP: 174.5 ± 21.08; final SBP: 127.0 ± 14.74; Initial DBP: 105.3 ± 15.5, final DBP: 78.11 ± 9.28 (p <0.0001), RAASDB group: initial SBP: 178.4 ± 21.08, final SBP: 134.4 ± 23.25, initial DBP: 102.7 ± 11.07, final DBP: 77.33 ± 13.75 (p <0.0001). Central systolic pressure had a greater reduction in the SNB group (p <0.005). ABPM had a significant reduction of SBP and DBP in both groups (SNB group p <0.0001 for SBP and DBP pre x post-intervention, RAASDB group p <0.0001 for SBP and DBP pre x post-intervention). No discontinuation due drug-related adverse events in both study groups. Conclusion: SNB and RAASDB associated with the beta-blocker in RHT patients with full adherence to the treatment showed excellent therapeutic efficacy. However, the SNB group disclosed a greater absolute reduction of central blood pressure values.