Pronóstico y recomendaciones para el manejo de la hipertensión clínica aislada

Abstract

Patients with isolated clinic hypertension (ICH) have a lower medium-term mortality rate than patients with sustained hypertension. However, these patients have greater target organ damage and therefore, in general, are at higher cardiovascular risk than normotensive individuals. Up to 18% of patients with ICH may present a high or very high added cardiovascular risk because of concomitant risk factors (smoking, dyslipidemia, diabetes, metabolic syndrome), or the presence of target organ damage or established cardiovascular disease. ICH is difficult to predict clinically and 24-hour ambulatory blood pressure monitoring is required for an accurate diagnosis. There will probably never be a highly sensitive screening test or algorithm that will identify patients requiring ambulatory blood pressure assessment. Therefore, given the prevalence of ICH (between 15 and 30% of hypertensive patients), ambulatory blood pressure monitoring is advisable in most hypertensive patients, at least initially. Defining ICH with the more restrictive cut-off point (24 h blood pressure < 127/77 mmHg or daytime blood pressure <130/80 mmHg) seems reasonable, particularly in patients at highest cardiovascular risk.