[Clinical practice guideline for the management of essential hypertension in the Peruvian Social Security (EsSalud)]

Authors

  • Jorge Luis Sotomayor-Perales Hospital III Juliaca, EsSalud, Juliaca, Perú.
  • Carolina J. Delgado-Flores Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud. Lima, Perú.
  • Jean Pierre Carrión-Arcela Hospital Luis Heysen Incháustegui, EsSalud, Lambayeque, Perú.
  • David Alonso Galván-Barrantes Hospital I Carlos Alcántara Butterfield, EsSalud, Lima, Perú.
  • José Mejía-Azañero Centro de Atención Primaria III San Isidro, EsSalud, Lima, Perú.
  • Luz Núñez-Osorio Policlínico Santa Cruz, EsSalud, Lima, Perú.
  • José Montes-Alvis Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud. Lima, Perú; EviSalud – Evidencias en Salud, Lima, Perú.
  • Sergio Goicochea-Lugo EviSalud – Evidencias en Salud, Lima, Perú; Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola. Lima, Perú.
  • Alvaro Taype-Rondan EviSalud – Evidencias en Salud, Lima, Perú; Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola. Lima, Perú.
  • Stefany Salvador-Salvador Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud. Lima, Perú.
  • Vladimir Santos-Sánchez Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud. Lima, Perú.

DOI:

https://doi.org/10.35434/rcmhnaaa.2024.171.1969

Keywords:

Essential Arterial Hypertension, Practice Guidelines as Topic, GRADE Approach, Evidence-Based Medicine

Abstract

Introduction: This article summarizes the clinical practice guide (CPG) for management of essential arterial hypertension in the Social Security of Peru (EsSalud). Objective: To provide evidence-based clinical recommendations for management of essential arterial hypertension in EsSalud. Methods: A guideline development group (GDG) was formed, which included specialist physicians and methodologists, who formulated clinical questions. Systematic searches of systematic reviews were conducted and - when deemed relevant - primary studies in PubMed during 2022. Evidence was selected to answer each of the proposed clinical questions. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic working meetings, the GDG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution No. 109-IETSI-ESSALUD-2022. Results: The CPG addressed 6 clinical questions regarding management. Based on these questions, 14 recommendations were formulated (7 strong and 7 conditional), 2 points of good clinical practice, and 1 flow chart. Conclusion: Evidence-based recommendations were statement for the management of patients with essential arterial hypertension.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Jorge Luis Sotomayor-Perales, Hospital III Juliaca, EsSalud, Juliaca, Perú.

1. Médico cardiólogo.

Carolina J. Delgado-Flores , Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud. Lima, Perú.

1. Químico Farmacéutico.

Jean Pierre Carrión-Arcela, Hospital Luis Heysen Incháustegui, EsSalud, Lambayeque, Perú.

1. Médico cardiólogo.

David Alonso Galván-Barrantes , Hospital I Carlos Alcántara Butterfield, EsSalud, Lima, Perú.

1. Médico en medicina familiar y comunitaria

José Mejía-Azañero, Centro de Atención Primaria III San Isidro, EsSalud, Lima, Perú.

1. Médico en medicina familiar y comunitaria

Luz Núñez-Osorio, Policlínico Santa Cruz, EsSalud, Lima, Perú.

1. Médico en medicina familiar y comunitaria

José Montes-Alvis , Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud. Lima, Perú; EviSalud – Evidencias en Salud, Lima, Perú.

1. Médico Cirujano.

Sergio Goicochea-Lugo, EviSalud – Evidencias en Salud, Lima, Perú; Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola. Lima, Perú.

1. Médico Cirujano.

Alvaro Taype-Rondan , EviSalud – Evidencias en Salud, Lima, Perú; Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola. Lima, Perú.

1. Médico cirujano, maestro en ciencias en investigación epidemiológica.

Stefany Salvador-Salvador, Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud. Lima, Perú.

1. Licenciada en obstetricia.

Vladimir Santos-Sánchez, Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud. Lima, Perú.

1. Médico cirujano, especialista en Medicina Integral y Gestión en Salud.

References

Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ (Clinical research ed). 2016;353:i2089.

Colombia, Ministerio de Salud y Protección Social, Guía de Práctica Clínica para el manejo de la hipertensión arterial primaria (HTA). 2da edición. Guía No 18. [GPC en internet]. Bogotá D.C: El Ministerio; 2017.

Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021 Sep 7;42(34):3227-3337. doi: https://doi.org/10.1093/eurheartj/ehab484.

National Clinical Guideline Centre (UK). Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34 [Internet]. London: Royal College of Physicians (UK); 2011 Aug.

Promoción, Prevención, Diagnóstico y Tratamiento de la Hipertensión Arterial en Primer Nivel de Atención. Guía de Práctica Clínica: Evidencias y Recomendaciones. México, CENETEC; 2021 [26/02/2021]. Disponible en: http://www.cenetec-difusion.com/CMGPC/GPC-IMSS-076-21/ER.pdf

Cortes-Bergoderi M, Thomas RJ, Albuquerque FN, et al. Validity of cardiovascular risk prediction models in Latin America and among Hispanics in the United States of America: a systematic review. Rev Panam Salud Publica 2012;32:131–9.

Lucaroni F, Cicciarella Modica D, Macino M, Palombi L, Abbondanzieri A, Agosti G, Biondi G, Morciano L, Vinci A. Can risk be predicted? An umbrella systematic review of current risk prediction models for cardiovascular diseases, diabetes and hypertension. BMJ Open. 2019 Dec 19;9(12):e030234.

Siontis GCM, Tzoulaki I, Siontis KC, et al. Comparisons of established risk prediction models for cardiovascular disease: systematic review. BMJ 2012;344:e3318.

Beswick AD, Brindle P, Fahey T, et al. A systematic review of risk scoring methods and clinical decision aids used in the primary prevention of coronary heart disease (supplement) [Internet]. London: Royal College of General Practitioners, UK: National Institute for Health and Clinical Excellence: Guidance, 2008.

Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-3104.

Lee LL, Mulvaney CA, Wong YKY, Chan ES, Watson MC, Lin HH. Walking for hypertension. Cochrane Database Syst Rev. 2021 Feb 24;2(2):CD008823.

Cao L, Li X, Yan P, Wang X, Li M, Li R, Shi X, Liu X, Yang K. The effectiveness of aerobic exercise for hypertensive population: A systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2019 Jul;21(7):868-876.

Fu Y, Feng Q, Wei Y, Fan L, Pan Y, Ji J, Lin C. Meta-Analysis of the Effect of Aerobic Training on Blood Pressure in Hypertensive Patients. Comput Math Methods Med. 2022 May 25;2022:9281661.

Saco-Ledo G, Valenzuela PL, Ruiz-Hurtado G, Ruilope LM, Lucia A. Exercise Reduces Ambulatory Blood Pressure in Patients with Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2020 Dec 15;9(24):e018487.

Igarashi Y, Nogami Y. Running to Lower Resting Blood Pressure: A Systematic Review and Meta-analysis. Sports Med. 2020 Mar;50(3):531-541.

Pedralli ML, Eibel B, Waclawovsky G, Schaun MI, Nisa-Castro-Neto W, Umpierre D, Pescatello LS, Tanaka H, Lehnen AM. Effects of exercise training on endothelial function in individuals with hypertension: a systematic review with meta-analysis. J Am Soc Hypertens. 2018 Dec;12(12):e65-e75.

Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev. 2020 Dec 12;12(12):CD004022.

D'Elia L, Galletti F, La Fata E, Sabino P, Strazzullo P. Effect of dietary sodium restriction on arterial stiffness: systematic review and meta-analysis of the randomized controlled trials. J Hypertens. 2018 Apr;36(4):734-743.

Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020 Apr;16(4):223-237. doi: 10.1038/s41581-019-0244-2. Epub 2020 Feb 5. doi: https://doi.org/10.1038/s41581-019-0244-2.

Al-Makki A, DiPette D, Whelton PK, Murad MH, Mustafa RA, Acharya S, Beheiry HM, Champagne B, Connell K, Cooney MT, Ezeigwe N, Gaziano TA, Gidio A, Lopez-Jaramillo P, Khan UI, Kumarapeli V, Moran AE, Silwimba MM, Rayner B, Sukonthasan A, Yu J, Saraffzadegan N, Reddy KS, Khan T. Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary. Hypertension. 2022 Jan;79(1):293-301. doi: https://doi.org/10.1161/HYPERTENSIONAHA.121.18192.

Wright JM, Musini VM, Gill R. First-line drugs for hypertension. Cochrane Database Syst Rev. 2018 Apr 18;4(4):CD001841. doi: https://doi.org/10.1002/14651858.CD001841.pub3.

Ficha Técnica Enalapril Stada 5 mg comprimidos EFG [Internet]. [citado 25 de noviembre de 2022]. Disponible en: https://cima.aemps.es/cima/pdfs/es/ft/62645/FT_62645.pdf.

Ficha Técnica Irbesartán Sandoz 150 mg comprimidos EFG [Internet]. [citado 25 de noviembre de 2022]. Disponible en: https://cima.aemps.es/cima/pdfs/es/ft/70159/70159_ft.pdf.

Ficha Técnica amlodipino cinfa 5 mg comprimidos EFG [Internet]. [citado 25 de noviembre de 2022]. Disponible en: https://cima.aemps.es/cima/dochtml/ft/65461/FichaTecnica_65461.

Yao J, Fan S, Shi X, Gong X, Zhao J, Fan G. Angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers on insulin sensitivity in hypertensive patients: A meta-analysis of randomized controlled trials. PLoS One. 2021 Jul 7;16(7):e0253492.

Cativo EH, Lopez PD, Cativo DP, Atlas SA, Rosendorff C. The Effect of Calcium Channel Blockers on Moderate or Severe Albuminuria in Diabetic, Hypertensive Patients. Am J Med. 2021 Jan;134(1):104-113.e3.

Wang G, Chen Y, Li L, Tang W, Wright JM. First-line renin-angiotensin system inhibitors vs. other first-line antihypertensive drug classes in hypertensive patients with type 2 diabetes mellitus. J Hum Hypertens. 2018 Jul;32(7):494-506.

Lv X, Zhang Y, Niu Y, Song Q, Zhao Q. Comparison of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on cardiovascular outcomes in hypertensive patients with type 2 diabetes mellitus: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2018 Apr;97(15):e0256.

Ficha Técnica atenolol cinfa 50 mg comprimidos EFG [Internet]. [citado 25 de noviembre de 2022]. Disponible en: https://cima.aemps.es/cima/pdfs/es/ft/63146/63146_ft.pdf.

Musini VM, Tejani AM, Bassett K, Puil L, Wright JM. Pharmacotherapy for hypertension in adults 60 years or older. Cochrane Database Syst Rev. 2019 Jun 5;6(6):CD000028.

Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, Grassi G, Jordan J, Poulter NR, Rodgers A, Whelton PK. Hypertension. Nat Rev Dis Primers. 2018 Mar 22;4:18014. doi: https://doi.org/10.1038/nrdp.2018.14.

Smith DK, Lennon RP, Carlsgaard PB. Managing Hypertension Using Combination Therapy. Am Fam Physician. 2020 Mar 15;101(6):341-349.

Garjón J, Saiz LC, Azparren A, Gaminde I, Ariz MJ, Erviti J. First-line combination therapy versus first-line monotherapy for primary hypertension. Cochrane Database Syst Rev. 2020 Feb 6;2(2):CD010316. doi: https://doi.org/10.1002/14651858.CD010316.pub2.

National Guideline Centre (UK). Evidence review for step 1 treatment: Hypertension in adults: diagnosis and management: Evidence review E. London: National Institute for Health and Care Excellence (NICE); 2019 Aug. Disponible en: https://www.nice.org.uk/guidance/ng136/evidence/e-step-1-treatment-pdf-6896748210.

Gao Q, Xu L, Cai J. New drug targets for hypertension: A literature review. Biochim Biophys Acta Mol Basis Dis. 2021 Mar 1;1867(3):166037. doi: https://doi.org/j.bbadis.2020.166037.

Park S. Ideal Target Blood Pressure in Hypertension. Korean Circ J. 2019 Nov;49(11):1002-1009. doi: https://doi.org/10.4070/kcj.2019.0261. .

Arguedas JA, Leiva V, Wright JM. Blood pressure targets in adults with hypertension. Cochrane Database Syst Rev. 2020 Dec 17;12(12):CD004349. doi: https://doi.org/10.1002/14651858.CD004349.pub3.

National Guideline Centre (UK). Evidence review for blood pressure targets: Hypertension in adults (update): Evidence review J. London: National Institute for Health and Care Excellence (NICE); 2022 Mar. Disponible en: https://www.nice.org.uk/guidance/ng136/evidence/j-blood-pressure-targets-pdf-11008446878.

Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev. 2020 Sep 9;9(9):CD010315. doi: https://doi.org/10.1002/14651858.CD010315.pub4

Aronow WS, Shamliyan TA. Blood pressure targets for hypertension in patients with type 2 diabetes. Ann Transl Med. 2018 Jun;6(11):199. doi: 10.21037/atm.2018.04.36. doi: https://doi.org/10.21037/atm.2018.04.36.

Tsai WC, Wu HY, Peng YS, Yang JY, Chen HY, Chiu YL, Hsu SP, Ko MJ, Pai MF, Tu YK, Hung KY, Chien KL. Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017 Jun 1;177(6):792-799. doi: https://doi.org/10.1001/jamainternmed.2017.0197.

Garrison SR, Kolber MR, Korownyk CS, McCracken RK, Heran BS, Allan GM. Blood pressure targets for hypertension in older adults. Cochrane Database Syst Rev. 2017 Aug 8;8(8):CD011575. doi: https://doi.org/10.1002/14651858.CD011575.pub2.

Murad MH, Larrea-Mantilla L, Haddad A, Spencer-Bonilla G, Serrano V, Rodriguez-Gutierrez R, et al. Antihypertensive agents in older adults: a systematic review and meta-analysis of randomized clinical trials. J Clin Endocrinol Metab. 2019;104(5):1575-1584. doi: https://doi.org/10.1210/jc.2019-00197.

Published

2024-04-07

How to Cite

1.
Sotomayor-Perales JL, Delgado-Flores CJ, Carrión-Arcela JP, Galván-Barrantes DA, Mejía-Azañero J, Núñez-Osorio L, Montes-Alvis J, Goicochea-Lugo S, Taype-Rondan A, Salvador-Salvador S, Santos-Sánchez V. [Clinical practice guideline for the management of essential hypertension in the Peruvian Social Security (EsSalud)] . Rev. Cuerpo Med. HNAAA [Internet]. 2024 Apr. 7 [cited 2024 Nov. 22];17(1). Available from: https://cmhnaaa.org.pe/ojs/index.php/rcmhnaaa/article/view/1969

Recommended Articles

1 2 3 > >>