ALTERNATIVAS TERAPÉUTICAS EN PACIENTES HIPERTENSOS INTOLERANTES A LOS INHIBIDORES DE LA ECA/ARA II: UNA REVISIÓN DE LA LITERATURA

Abstract

Systemic arterial hypertension (SAH) is a chronic multifactorial condition clinically defined by elevated blood pressure levels (SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg). SAH is classified into stage 1 (SBP 130-139 mmHg and/or DBP 80-89 mmHg) and stage 2 (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg). Treatment of SAH is multifactorial and includes both pharmacological and non-pharmacological therapy.^1,2 The main drug classes include thiazide diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and calcium channel blockers (CCBs). Some patients develop adverse drug reactions and require alternative therapies.⁴ Intolerance to angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) can be defined as the occurrence of clinically relevant adverse effects that prevent the safe and continuous maintenance of these therapies, requiring their definitive discontinuation. In the case of ACE inhibitors, the events most frequently associated with intolerance include persistent dry cough and angioedema, both largely related to bradykinin accumulation resulting from angiotensin-converting enzyme inhibition. Other manifestations, such as significant hyperkalemia and deterioration of renal function, may also limit the use of this class, especially in patients with associated comorbidities. Although ARBs have a lower incidence of these adverse effects because they do not interfere with bradykinin degradation, cases of intolerance, including angioedema, have been described, suggesting the possibility, albeit rare, of cross-reactivity between these pharmacological classes. Therefore, identifying intolerance requires careful clinical evaluation, since its presence directly influences the choice of therapy and the appropriate management of systemic arterial hypertension.