Intervenciones farmacológicas y no farmacológicas al tratamiento de un paciente diagnosticado con hipertensión arterial resistente y ateromatosis coronaria difusa.

Abstract

Resistant arterial hypertension represents a worldwide problem which consists of resistance to pharmacological treatment that may be due to lack of adherence to treatment that causes an increase in blood pressure outside the reasonable goal PA<130/80 mmHg. A clinical case of a patient who has been diagnosed with resistant arterial hypertension and diffuse coronary atheromatosis, with an evolution of 10 years, in treatment with enalapril at the maximum tolerable dose, hydrochlorothiazide 25 mg, bisoprolol 5 mg/day, is presented. Additionally, the patient visited the emergency room due to elevated BP >200/110 mmHg, with chest pain, angioedema, no changes in the ECG, and normal troponins. The general objective was to analyze a clinical case of a patient diagnosed with resistant arterial hypertension and diffuse coronary atheromatosis, through bibliographic reviews of scientific articles, for the recommendation of a pharmacological and non-pharmacological treatment. In order to fulfill the established objective, a search of bibliographic information from scientific articles, scientific journals and web pages was carried out to propose alternatives in the treatment of the patient. Based on what was investigated, an adjustment to the pharmacological treatment of the patient is proposed with the incorporation of a fourth antihypertensive drug, spironolactone, changing enalapril for losartan, hydrochlorothiazide for chlorthalidone, and bisoprolol for amlodipine to control resistant hypertension, as well as non-pharmacological measures, a change in lifestyle, implement the DASH diet, use notifications (alarm, call) to take the medication in order to improve adherence to treatment.