Tratamento hipertensivo nefroprotetor: medicamento de escolha para pacientes com nefropatia diabética
Nephroprotective hypertension treatment: drug of choice for patients with diabetic nephropathy
Caio Cardoso Coelho, Ana Clara Monteiro de Araújo, Isis Chaves Souza Alves, Taiane do Socorro Silva Natividade, Anderson Bentes de Lima
Resumo
Objetivo: Revisar a literatura científica, considerando os prós e contras das terapias farmacológicas anti-hipertensivas e suas indicações para efeito nefroprotetor em pacientes nefropatas. Método: Trata-se de um estudo de revisão integrativa elaborada de acordo com os cinco passos da revisão integrativa, propostos por Whittemore. O PubMed e a Biblioteca Virtual em Saúde foram consultados nas bases de dados SciELO, Medline e Lilacs. Resultados: As principais escolhas são o Captopril, como representante da IECA e a Losartana, como representante do BRA. Ambas apresentam alterações no SRAA, e no caso da IECA também há alteração no sistema cinina-calicreína. Esse mecanismo de ação leva aos efeitos adversos relatados na literatura, sendo a grande maioria considerado bem toleráveis. Considerações finais: Não há consenso na literatura quanto a melhor escolha entre as classes, entretanto os efeitos adversos podem ser considerados na escolha do fármaco e de acordo com a situação clínica apresentada.
Palavras-chave
Abstract
Purpose: To review the scientific literature, considering the pros and cons of pharmacological antihypertensives therapies and their indications for nephroprotective effect in nephropathic patients. Methods: This is an integrative review of literature elaborated according to the five phases of the integrative review, proposed by Whittemore; the PubMed and the Health Virtual Library were consulted using the databases SciELO, Medline and Lilacs. Results: The main choices are Captopril as ACEI representative and Losartana as ARB representative. Both have alterations in the RAAS, and in the case of ACEI there is also alteration in the kinin-kallikrein system. This mechanism of action leads to adverse effects reported in the literature, and the vast majority are considered well tolerable. Conclusion: There is no consensus in the literature regarding the best choice between medication classes, however adverse effects can be considered in the choice of drug and according to the clinical situation presented.
Keywords
Referências
1. Malachias MV, Souza WKSB, Plavnik FL, Rodrigues CIS, Brandão AA, Neves MFT et al. 7ª Diretriz Brasileira de hipertensão arterial. Arq BRA Cardiol. 2016;107(3):1-103.
2. Malta DC, Gonçalves RPF, Machado ÍE, Freitas MIF, Azeredo C, Szwarcwald CL. Prevalência da hipertensão arterial segundo diferentes critérios diagnósticos, Pesquisa Nacional de Saúde. Rev Bras Epidemiol. 2018;21(Suppl 1):1-15. http://dx.doi.org/10.1590/1980-549720180021. supl.1.
3. Shen Y, Chang C, Zhang J, Jiang Y, Ni B, Wang Y. Prevalence and risk factors associated with hypertension and prehypertension in a working population at high altitude in China: a cross-sectional study. Environ Health Prev Med. 2017;22(1):19. http://dx.doi.org/10.1186/s12199-017-0634-7. PMid:29165123.
4. Silva MM, Bucharles SGE, Nazario AR, Riella MC. Doença renal do diabetes. In: Riella MC. Princípios de nefrologia e distúrbios hidroeletrolíticos.
6. ed. Rio de Janeiro: Guanabara Koogan; 2018. 1116 p.
5. Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison Himmelfarb C, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017;71(6):1269-324. http://dx.doi.org/10.1161/HYP.0000000000000066. PMid:29133354.
6. Silva BVD, Ferreira LN, Barros JBS, Santos RS, Reis AAS. Farmacoterapia de pacientes portadores de hipertensão arterial sistêmica na região brasil central. Acta Biologica Brasiliensia. 2019;2(1):101-17.
7. Whittemore R. Analysis of integration in nursing science and practice. J Nurs Scholarsh. 2005;37(3):261-7. http://dx.doi.org/10.1111/j.1547-5069.2005.00045.x. PMid:16235868.
8. Rang R, Ritter JM, Flower RJ, Henderson G. Rang & Dale Farmacologia. 8. ed. Rio de Janeiro: Elsevier Brasil; 2015.
9. Hilal-Dandan R, Brunton L. Goodman and gilman manual of pharmacology and therapeutics. 2. ed. Philadelphia: McGraw Hill Professional; 2013.
10. Heerspink HJL, Gansevoort RT. Albuminuria é um alvo terapêutico apropriado em pacientes com DRC: a visão profissional. Revista Clínica da Sociedade Americana de Nefrologia. 2015;10(6):1079-88.
11. Pereira ANP. Prevalência da tosse em pacientes com hipertensão arterial refratária em uso de Inibidores da Enzima de Conversão da Angiotensina [Internet]. Salvador: Universidade Federal da Bahia. Repositório Institucional 2017. [citado em 2019 dez 16]. Disponível em: https://repositorio.ufba.br/ri/handle/ri/21346
12. Gonzaga CC, Passarelli JR, Amodeo C. Interações medicamentosas: inibidores da enzima conversora da angiotensina, bloqueadores dos receptores da angiotensina II, inibidores diretos da renina. Rev Bras Hipertens. 2009;16(4):221-5.
13. Jamerson KA, Bakris GL, Wun CC, Dahlöf B, Lefkowitz M, Manfreda S, et al. Rationale and design of the avoiding cardiovascular events through combination therapy in patients living with systolic hypertension (ACCOMPLISH) trial: the first randomized controlled trial to compare the clinical outcome effects of first-line combination therapies in hypertension. Am J Hypertens. 2004;17(9):793-801. http://dx.doi.org/10.1016/S0895-7061(04)00840-4. PMid:15363822.
14. Leehey DJ, Zhang JH, Emanuele NV, Whaley-Connell A, Palevsky PM, Reilly RF, et al. BP and Renal Outcomes in Diabetic Kidney Disease: the Veterans Affairs Nephropathy in Diabetes Trial. Clin J Am Soc Nephrol. 2015;10(12):2159-69. http://dx.doi.org/10.2215/CJN.02850315. PMid:26482258.
15. Albayrak B, Çankaya E, Çetinkaya R, Cerrah S, Bilen Y. Os efeitos de combinações duplas e triplas de trandolapril, telmisartan e verapamil na proteinúria evidente em pacientes com nefropatia diabética. Revista Saudita de Doenças Renais e Transplante. 2016;27(3):512.
16. Ruggenenti P, Trillini M, P. Barlovic D, Cortinovis M, Pisani A, Parvanova A, et al. Effects of valsartan, benazepril and their combination in overt nephropathy of type 2 diabetes: a prospective, randomized, controlled trial. Diabetes Obes Metab. 2019;21(5):1177-90. http://dx.doi.org/10.1111/dom.13639. PMid:30793466.
17. Huang R, Feng Y, Wang Y, Qin X, Melgiri ND, Sun Y, et al. Comparative efficacy and safety of antihypertensive agents for adult diabetic patients with microalbuminuric kidney disease: a network meta-analysis. PLoS One. 2017 Jan;12(1):e0168582. http://dx.doi.org/10.1371/journal.pone.0168582. PMid:28045910.
18. Zou H, Zhou B, Xu G. SGLT2 inhibitors: a novel choice for the combination therapy in diabetic kidney disease. Cardiovasc Diabetol. 2017 May;16(1):65. http://dx.doi.org/10.1186/s12933-017-0547-1. PMid:28511711.
19. Stephan D, Gaertner S, Cordeanu EM. A critical appraisal of the guidelines from France, the UK, Europe and the USA for the management of hypertension in adults. Arch Cardiovasc Dis. 2015;108(8-9):453-9. http://dx.doi.org/10.1016/j.acvd.2015.05.006. PMid:26113481.
20. Gosho M. Risk of hypoglycemia after concomitant use of antidiabetic, antihypertensive, and antihyperlipidemic medications: a database study. J Clin Pharmacol. 2018;58(10):1324-31. http://dx.doi.org/10.1002/jcph.1147. PMid:29762878.
21. Salvador GLO, Marmentini VM, Cosmo WR, Junior EL. Angiotensin-converting enzyme inhibitors reduce mortality compared to angiotensin receptor blockers: systematic review and meta-analysis. Eur J Prev Cardiol. 2017;24(18):1914-24. http://dx.doi.org/10.1177/2047487317728766. PMid:28862020.
22. Gawrys J, Gawrys K, Szhidewicz-Krupska E, Derkacz A, Mochol J, Doroszko A. Interactions between the cyclooxygenase metabolic pathway and the renin-angiotensin-aldosterone systems: their effect on cardiovascular risk, from theory to the clinical practice. Biomed Res Int. 2018:7902081. https://doi.org/10.1155/2018/7902081.
23. Chen M, Zhou SY, Fabriaga E, Zhang PH, Zhou Q. Food-drug interactions precipitated by fruit juices other than grapefruit juice: an update review. JFDA. 2018;26(2):S61-71. http://dx.doi.org/10.1016/j.jfda.2018.01.009. PMid:29703387.
24. Bello BT, Amira CO. Pattern and predictors of urine protein excretion among patients with Type 2 diabetes attending a single tertiary Hospital in Lagos, Nigeria. Saudi J Kidney Dis Transpl. 2017;28(6):1381-8. http://dx.doi.org/10.4103/1319-2442.220869. PMid:29265051.
25. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018 Oct;36(10):1953-2041. http://dx.doi.org/10.1097/HJH.0000000000001940. PMid:30234752.
26. Brunton LL, Knollmann BC, Hilal-Dandan R. Goodman & Gilman’s the pharmacological basis of therapeutics. Philadelphia: McGraw-Hill Education; 2018.
27. Gismondi RA, Oigman W, Bedirian R, Pozzobon CR, Ladeira MCB, Neves MF. Comparison of benazepril and losartan on endothelial function and vascular stiffness in patients with Type 2 diabetes mellitus and hypertension: a randomized controlled trial. J Renin Angiotensin Aldosterone Syst. 2015;16(4):967-74. http://dx.doi.org/10.1177/1470320315573681. PMid:25784709.
Submetido em:
16/12/2019
Aceito em:
26/05/2020
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email