Hipertensión arterial: etiopatogenia, clínica, historia natural, complicaciones y tratamiento. Hipertensión arterial en el anciano y en el embarazo

Abstract

Hypertension (HT) is a complex disease characterized by a persistent increase in blood pressure associated with an increased risk of certain complications and premature death. This update provides an analysis of the fundamental concepts related to HT, including its etiology, etiopathogenic mechanisms, clinical manifestations, natural history of the disease, associated complications, and treatment strategies, with a particular focus on vulnerable groups such as older adults and pregnant people. In addition, risk factors and cardiovascular risk modifiers are studied. The importance of detecting resistant and secondary hypertension is emphasized as well as the effect of lifestyle habits and comorbidities on disease progression. Treatment includes, among other measures, lifestyle modifications, following a Mediterranean diet, reducing sodium intake, weight control, regular exercise, and a personalized pharmacological approach that combines angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), calcium channel blockers, and diuretics. New strategies such as renal denervation and the use of innovative agents such as GLP-1 receptor agonists and aldosterone synthase inhibitors are discussed.