ADRIANA ELIZABETH ORTIZ MONTA MONTAÑEZ ÑEZ – 1094280936
CAP 16
MICROCIRCULACIÓN Y SISTEMA LINFÁTICO: INTERCAMBIO DE LÍQUIDO CAPILAR, LÍQUIDO INTERSTICIAL Y FLUJO LINFÁTICO
El prinip!l "#$%&i'" (% l! )*ni+n ir*l!&"ri! &i%n% l*,!r %n l! -ir"ir*l!i+n .*% %/ %l &r!n/p"r&% (% n*&ri%n&%/ !i! l"/ &%$i("/ %li-in!i+n (% r%/&"/ %l*l!r%/
1. ESTRUCTURA ESTRUCTURA DE LA MICROCI MICROCIRCULA RCULACIÓN CIÓN Y DEL SISTEMA SISTEMA CAPILAR CAPILAR En ,%n%r!l !/! !r&%ri! n*&rii! /% r!-i)i! (% 6 ! 8 '%%/ p!r! )"r-!r l!/ !r&%ri"l!/ .*% ! /* '% '*%l'%n ! r!-i)i!r/% %n /*/ %&r%-"/ ("n(% !p"r&!n /!n,r% !l !pil!r L!/ arterias /"n '!/"/ -*/*l!r%/ (% (i5-%&r"/ '!ri!#l%/ l!/ metaarteriolas p"r %l "n&r!ri" &i%n%n )i#r!/ -*/*l!r%/ li/!/ %n p*n&"/ El esfínter esfínter precapilar precapilar %/ %l p*n&" ("n(% /% "ri,in! *n !pil!r '%r(!(%r" .*% "n&i%n% *n! )i#r! -*/*l!r li/! L!/ '7n*l!/ /% "n&r!%n "n -5/ )*%r! ! p%/!r (% /* !p! -*/*l!r (7#il p"r /* p"! pr%/i+n L!/ -%&!!r&%ri"l!/ l"/ %/)n&%r%/ %/&5n %n "n&!&" "n l"/ &%$i("/ p"r l" .*% l"/ !-#i"/ %n %ll"/ &!-#i7n !)%&!n ! l"/ '!/"/ %n %l "n&r"l (%l )l*$" l"!l E/&r*&*r! (% l! p!r%( !pil!r C"-p*%/&! p"r *n! !p! *ni%l*l!r (% 7l*l!/ %n("&%li!l%/ %/&5 r"(%!(! p"r *n! -%-#r!n! #!/!l -* )in! %n %l %&%ri"r (%l !pil!r L"/ :p"r"/; %n l! p!r%( /"n *n !n!l *r'" ! -"(" (% %n(i(*r! .*% (%/!n (%/!n/! /! %n l! #!/% %n&r% 7l*l!/ 7l*l!/ %n("&% %n("&%li! li!l%/ l%/ "n"i(" "n"i(" "-" "-" espacio intercelular ! p%/!r /* p%.*%<" &!-!<" %l )l*$" (% -"l7*l!/ i(r"/"l*#l%/ -"l7*l!/ (% !,*! (i)*n(%n r5pi(!-%n&% En l!/ 7l*l!/ %n("&%li!l%/ &!-#i7n /% )"r-!n '%/*l!/ (% pl!/-!l%-! " )"r-!(!/ !/ p"r pr"&%n pr"&%n!/ !/ !'%"l !'%"lin! in!// =!/"i! =!/"i!(!/ (!/ ! "l%/& "l%/&%r"l %r"l cavé cavéol olas as )"r-!( %/)in,"lpi("/> "n )*ni+n (% %n("i&"/i/ &r!n/i&"/i/ (% -!r"-"l7*l!/ Tip"/ %/p%i!l%/ (% :p"r"/; %n l"/ !pil!r%/ (% !l,*n"/ +r,!n"/ 1 En %l %r%# %r%#r" r" *ni"n *ni"n%/ %/ %/&r %/&r% %! !// .*% .*% p%r-i& p%r-i&% % %l )l*$ )l*$" " (% -"l7 -"l7* *l! l!// p%.*%
2 En %l ,!(" !p%r&*r!/ !-pli!/ p%r-i&i%n(" (% -"l7*l!/ (i/*%l&!/ %n %l pl!/-! H!/&! pr"&%n!/ 3 M%-#r!n!/ !pil!r%/ ,!/&r"in&%/&in!l%/ in&%r-%(i!ri!/ %n&r%/ -*/*l" % ,!(" 4 En l"/ !pil!r%/ ,l"-%r*l!r%/ (%l ri<+n /% )"r-!n -%-#r!n!/ "'!l%/ fenestraciones p"r ("n(% p!/!n -"l7*l!/ p%.*%
2. FLUJO DE SANGRE EN LOS CAPILARES: VASOMOTILIDAD ?% %n&i%n(% p"r vasomotilidad !l )l*$" in&%r-i&%n&% (% /!n,r% p"r l"/ !pil!r%/ -%(i!(" p"r l!/ -%&!!r&%ri"l!/ %/)n&%r%/ !pil!r%/ •
R%,*l!i+n (% l! '!/"-"&ili(!( El )!&"r .*% in)l*% %n l! !p%r&*r! i%rr% (% l!/ %/&r*&*r!/ %/ l! "n%n&r!i+n (% ",%n" %n l"/ &%$i("/
C*!n(" (i/-in*% l! !n&i(!( %n %l &%$i(" /% !&i'! l"/ p%r"("/ in&%r-i&%n&%/ (% )l*$" /* (*r!i+n !p"r&!n(" %l ",%n" "&r"/ n*&ri%n&%/ .*% n%%/i&% %l &%$i(" •
@*ni+n -%(i! (%l /i/&%-! !pil!r p"r l! !n&i(!( (% !pil!r%/ .*% ! l! )*ni+n in&%r-i&%n&% (% -!n%r! ,l"#!l %/ /*p%r!(! p"r l" .*% '! ! !#%r *n! '%l"i(!( pr%/i+n !pil!r -%(i! (%l )l*$" /!n,*n%" *n! '%l"i(!( (% &r!n/)%r%ni! -%(i! (% l!/ /*/&!ni!/ %n&r% !pil!r li.*i(" in&%r/&ii!l
3. INTERCAMBIO DE AGUA, NUTRIENTES Y OTRAS SUSTANCIAS ENTRE LA SANGRE Y EL LÍQUIDO INTERSTICIAL El -%(i" (% &r!n/p"r&% %n&r% %l pl!/-! %l l.*i(" in&%r/&ii!l %/ l! (i)*/i+n "-" "n/%*%ni! (%l -"'i-i%n&" &7r-i" (% l!/ -"l7*l!/ (% !,*! "&r!/ /*/&!ni!/ •
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?i *n! /*/&!ni! %/ lip"/"l*#l% (i)*n(% r5pi(! (ir%&!-%n&% ! &r!'7/ (% l! -%-#r!n! =C"2 02> M"l7*l!/ "-" %l !,*! N! ,l*"/! l"r*r" p!/!n ! &r!'7/ (% l"/ p"r"/ p"r.*% /"n in/"l*#l%/ %n l! -%-#r!n! lip(i! "n (i)*/i+n r5pi(!
E)%&" (%l &!-!<" -"l%*l!r /"#r% %l p!/" ! &r!'7/ (%l p"r" l! p%r-%!#ili(!( (% l"/ p"r"/ (%l !pil!r '!r! p!r! l!/ /*/&!ni!/ /%,n /* (i5-%&r" -"l%*l!r &%ni%n(" %n *%n&! .*% p!r! (i'%r/"/ &%$i("/ %i/&% *n! p%r-%!#ili(!( (i)%r%n&% /%,n l!/ !n&i(!(%/ %l n*&ri%n&% .*% n%%/i&%
E)%&" (% l! (i)%r%ni! (% "n%n&r!i+n %n l! '%l"i(!( n%&! (% (i)*/i+n ! &r!'7/ (% l! -%-#r!n! !pil!r L! '%l"i(!( n%&! (% (i)*/i+n (% *n! /*/&!ni! ! &r!'7/ (% *!l.*i%r -%-#r!n! %/ pr"p"ri"n!l ! l! "n%n&r!i+n (% l! /*/&!ni! %n&r% l"/ ("/ l!("/ (% l! -%-#r!n! En&r% -!"r /%! l! (i)%r%ni! (% "n%n&r!i+n ! !-#"/ l!("/ -!"r %l )l*$" (% l! /*/&!ni! %n *n! (ir%i+n (% l! -%-#r!n!
. INTERSTICIO Y LIQUIDO INTERSTICIAL El in&%r/&ii" %/&5 )"r-!(" p"r ("/ %/&r*&*r!/ prinip!l%/ !%/ (% )i#r!/ (% "l5,%n" .*% pr"p"ri"n!n l! -!"r! (% l! )*%r! &%n/i"n!l (% l"/ &%$i("/ )il!-%n&"/ (% pr"&%",li!n"/ .*% )"r-!n *n! %/&%rill! (% )il!-%n&"/ p%.*%<"/ :%l; %n %l in&%r/&ii" "n&i%n% l"/ -i/-"/ "-p"n%n&%/ (%l pl!/-! p%r" "n -* p"!/ pr"&%n!/ p"r.*% %/&!/ n" !&r!'i%/!n l"/ p"r"/ (% l"/ !pil!r%/ %l l.*i(" in&%r/&ii!l $*n&" "n l"/ pr"&%",li!n"/ )"r-!n *n! %/p%i% (% gel tisular L! (i)*/i+n ! &r!'7/ (%l %/ r5pi(! L.*i(" :li#r%; %n %l in&%r/&ii" E/ %l l.*i(" .*% n" .*%(! !&r!p!(" %n %l ,%l p"r l" &!n&" !r%% (% pr"&%",li!n"/
!. LA FILTRACIÓN DE LÍQUIDOS A TRAV"S DE LOS CAPILARES DETERMINADA POR LAS PRESIONES #IDROSTATICAS Y COLOIDOSMOTICA Y COEFICIENTE DE FILTRACIÓN CAPILAR F$%&'() *% S+(&-/: D%&%r-in!n /i %l l.*i(" /!l% (% l! /!n,r% !l l.*i(" in&%r/&ii!l " '! %n (ir%i+n "n&r!ri!
1 L! =P> &i%n(% ! )"r!r l! /!li(! (%l l.*i(" ! &r!'7/ (% l! -%-#r!n! 2 =Pi)> &i%n(% ! )"r!r l! %n&r!(! (% l.*i(" *!n(" %/ => l! /!li(! *!n(" %/ => 3 =p> pr"'"! l! "/-"/i/ (%l l.*i(" !l in&%ri"r (% l! -%-#r!n! 4 =i)> pr"'"! l! "/-"/i/ (%l l.*i(" !i! %l %&%ri"r (% l! -%-#r!n! !pil!r ?i l! pr%/i+n n%&! %/ p"/i&i'! !#r5 )il&r!i+n (% l.*i(" p"r l"/ !pil!r%/ /i %/ p"/i&i'! !#r5 !#/"ri+n (% l.*i(" (%/(% l"/ %/p!i"/ in&%r/&ii!l%/ !l !pil!r Pr%/i+n i(r"/&5&i! !pil!r •
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M7&"(" (% -ir"pip%&! p!r! -%(ir l! pr%/i+n !pil!r ?% %-p*$! *n! pip%&! (% 'i(ri" -ir"/+pi! (ir%&!-%n&% %n %l !pil!r l! pr%/i+n /% -i(% "n *n -ir"-!n+-%&r" (!n(" pr%/i"n%/ (% 3040 --H, %n %&r%-" !r&%ri!l 101F %n %&r%-"/ '%n"/"/ 2F %n "n! -%(i! M7&"(" i/",r!'i-7&ri" p!r! l! -%(ii+n (% l! pr%/i+n !pil!r ?% r%!li! "n *n! #!l!n! ,!'i-7&ri! p*%/ l! pr%/i+n !pil!r /% -!&i%n% "n/&!n&% -i%n&r!/ /i-*l&5n%!-%n&% (i/-in*% l! pr%/i+n !r&%ri!l !*-%n&! l! pr%/i+n '%n"/! !/ /% !l*l! in(ir%&!-%n&% %l !-#i" .*% /% r%!li+ !l #!$!r l! pr%/i+n '%n"/! ! !l,*n! p!r&% (%l "r,!ni/-" /* !*-%n&" (% pr%/i+n '%n"/! p!r! %l -!n&%ni-i%n&" n"r-!l (% l! pr%/i+n
Pr%/i+n i(r"/&5&i! (%l l.*i(" in&%r/&ii!l En %l &%$i(" /*#*&5n%" l! pr%/i+n (%l l.*i(" in&%r/&ii!l %/ *n"/ -- -%n"r .*% l! pr%/i+n !&-"/)7ri! p"r l" .*% /% (%n"-in!n valores negativos *!n(" l!/ pr%/i"n%/ /"n -!"r%/ "-" %n l"/ ri<"n%/ /% (i%n .*% /"n positivas.
M7&"("/ p!r! (%&%r-in!r l! pr%/i+n !pil!r
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D%&%r-in!i+n (% pr%/i+n p"r -ir"pip%&! D%&%r-in!i+n (% l! pr%/i+n %n 5p/*l!/ *%!/ p%r)"r!(!/
Pr%/i+n (%l l.*i(" in&%r/&ii!l %n &%$i("/ )ir-%-%n&% %n!p/*l!("/ Al,*n"/ &%$i("/ (%l "r,!ni/-" %/&5n r"(%!("/ p"r *n! !r!/! r,i(! "-" %l ri<+n %l %r%#r" "$" %& P%r-i&i%n(" .*% l! pr%/i+n (%l l.*i(" in&%r/&ii!l /%! -%n"r .*% l!/ pr%/i"n%/ %$%ri(! %n %l %&%ri"r (% l"/ &%$i("/ p"r /*/ !r!/!/
0. SISTEMA LINFÁTICO E/ *n '! !%/"ri! ! &r!'7/ (% l! *!l %l l.*i(" p*%(% )l*% (%/(% l"/ %/p!i"/ in&%r/&ii!l%/ !i! l! /!n,r% E/&% &r!n/p"r&! pr"&%n!/ -!r"p!r&*l!/ .*% n" p"(r5n /%r %li-in!(!/ p"r !#/"ri+n !i! l"/ !pil!r%/ /!n,*n%"/ L"/ '!/"/ lin)5&i"/ (%l "r,!ni/-" T"("/ l"/ '!/"/ lin)5&i"/ (% l! -i&!( in)%ri"r /% '!i!r!n %n "n(*&" &"r5i" .*% /% '! !i! '%n! *,*l!r i.*i%r(! ! /*#l!'i! i.*i%r(! L! lin)! (% l! -i&!( i.*i%r(! (% l! !#%! #r!" i.*i%r(" !l,*n!/ "n!/ (%l &+r! (r%n!n %n "n(*&" &"r5i" L! lin)! (%l l!(" (%r%" (% !#%! *%ll" #r!" !l,*n!/ "n!/ (%l &+r! (r%n!n %n "n(*&" &"r5i" (%r%" .*% (r%n! %n /*#l!'i! (%r%! *,*l!r in&%rn! C!pil!r%/ lin)5&i"/ &%r-in!l%/ /* p%r-%!#ili(!( L! !n&i(!( n"r-!l (% lin)! %/ n"r-!l-%n&% (% 23l !l (! %/ -* i-p"r&!n&% p"r.*% l!/ pr"&%n!/ (% !l&" p%/" -"l%*l!r n" p*%(%n /%r5 !#/"r#i(!/ (%/(% l"/ &%$i("/ (% "&r" -"(" L"/ lin)5&i"/ &i%n%n '5l'*l!/ %n l"/ %&r%-"/ (% l"/ !pil!r%/ lin)5&i"/ &%r-in!l%/ &!-#i7n %n %l r%"rri(" (% l"/ '!/"/ -!"r%/ L! )"r-!i+n (% l! lin)! L! lin)! (%ri'! (%l l.*i(" in&%r/&ii!l .*% )l*% %n l"/ lin)5&i"/ l! "n%n&r!i+n %n pr"&%n!/ !l!n! *n pr"-%(i" (% 2,G(L En %l ,!(" l! lin)! !l!n! ! &%n%r *n! "n%n&r!i+n (% pr"&%n!/ (%l 34 ,G(L El /i/&%-! lin)5&i" &!-#i7n %/ i-p"r&!n&% %n l! !#/"ri+n (% l!/ ,r!/!/ (% l"/ !li-%n&"/ p"r -%(i" (% %ll! l!/ #!&%ri!/ 'i!$!n !/&! l"/ ,!n,li"/ lin)5&i"/ ("n(% /%r5n %li-in!(!/
%l"i(!( (%l )l*$" lin)5&i" En *n *-!n" %n r%p"/" p!/!n 100-l p"r "r! %n %l )l*$" (%l "n(*&" &"r5i" 20-l !! l! ir*l!i+n (%/(% "&r"/ !n!l%/ (!n(" n '!l"r (% 120-lG E)%&" (% l! pr%/i+n (%l l.*i(" in&%r/&ii!l %n %l )l*$" lin)5&i" L! pr%/i+n (%l l.*i(" in&%r/&ii!l %/ (% 6--H, *!n(" !*-%n&! ! 0 --H, =pr%/i+n !&-"/)7ri!> %l )l*$" !*-%n&! -5/ (% 20 '%%/ p"r l" .*% *!l.*i%r )!&"r .*% !*-%n&% l! pr%/i+n (%l l.*i(" in&%r/&ii!l !*-%n&! %l )l*$" lin)5&i"/ l"/ '!/"/ lin)5&i"/ %/&5n )*ni"n!n(" n"r-!l-%n&% E/&"/ )!&"r%/ /"n El%'!i+n (% l! pr%/i+n i(r"/&5&i! !pil!r D%/%n/" (% l! pr%/i+n "l"i("/-+&i! (%l pl!/-! A*-%n&" (% l! pr%/i+n "l"i("/-+&i! (%l l.*i(" in&%r/&ii!l A*-%n&" (% l! p%r-%!#ili(!( %n l"/ !pil!r%/ L! #"-#! lin)5&i! !*-%n&! %l )l*$" lin)5&i" L"/ '!/"/ lin)5&i"/ (% r%",i(! " -!"r%/ /% %/&ir!n p"r %l l.*i(" %l -/*l" li/" (% /* p!r%( /% "n&r!% !*&"-5&i!-%n&% A(%-5/ !(! /%,-%n&" (%l '!/" lin)5&i" %n&r% '5l'*l!/ /*%/i'!/ )*ni"n! "-" *n! #"-#! !*&"-5&i! in(%p%n(i%n&% "n l" .*% "n/i,*%n ll%'!r %l l.*i(" !/&! l! ir*l!i+n /!n,*n%! A(%-5/ (%l #"-#%" !*/!(" p"r l! "-pr%/i+n %&%rn! in&%r-i&%n&% (% l"/ '!/"/ lin)5&i"/ ! "&r"/ )!&"r%/ .*% "-pri-%n "-" l" /"n C"n&r!i+n (% l"/ -/*l"/ %/.*%l7&i"/ ir*n(!n&%/ M"'i-i%n&" (% !(! p!r&% (%l *%rp" P*l/!i"n%/ (% l!/ !r&%ri!/ !(!%n&%/ ! l"/ lin)5&i"/ "-pr%/i+n (% l"/ &%$i("/ p"r "#$%&"/ /i&*!("/ )*%r! (%l *%rp" L! #"-#! lin)5&i! %/ -* !&i'! (*r!n&% %l %$%rii" (*r!n&% %l r%p"/" %l )l*$" /% !% !/i %r" B"-#! lin)5&i! !pil!r %l !pil!r lin)5&i" &%r-in!l &!-#i7n p*%(% #"-#%!r lin)! "-" l!/ p!r%(%/ (% l"/ lin)5&i"/ %/&5n !(%ri(!/ ! l!/ 7l*l!/ &i/*l!r%/ p"r /*/ )il!-%n&"/ (% !nl!$% *!l.*i%r %%/" (% l.*i(" (%n&r" (%l &%$i(" pr"'"! in!+n !i%n(" .*% l"/ )il!-%n&"/ &ir%n (% l! p!r%( (% l"/ !pil!r%/ lin)5&i"/
%l )l*$" %n&r! %n %l !pil!r D%/p*7/ l! pr%/i+n (%l in&%ri"r !*-%n&! *!n(" /% "-pri-% %l &%$i(" pr"'"! %l i%rr% (% l!/ '5l'*l!/ l! pr%/i+n %-p*$! l! lin)! ! &r!'7/ (% l"/ %/p!i"/ in&%r%l*l!r%/ !i! %l lin)5&i" "l%&"r
CAP 19
FUNCIÓN DOMINANTE DE LOS RIONES EN EL CONTROL A LARGO PLAO DE LA PRESIÓN ARTERIAL Y EN LA #IPERTENSIÓN SISTEMA RENINA ANGIOTENSINA: FUNCIÓN EN EL CONTROL DE LA PRESIÓN ARTERIAL El /i/&%-! r%nin!!n,i"&%n/in! =RA?> " r%nin!!n,i"&%n/in!!l("/&%r"n! =RAA?> %/ *n /i/&%-! "r-"n!l .*% !*(! ! r%,*l!r ! l!r," pl!" l! pr%/i+n /!n,*n%! %l '"l*-%n %&r!%l*l!r "rp"r!l L! renina %/ *n! %ni-! pr"&%i! li#%r!(! p"r l"/ ri<"n%/ *!n(" l! pr%/i+n !r&%ri!l (%/i%n(% (%-!/i!(" l! r%nin! /% /in&%&i! !l-!%n! %n *n! )"r-! in!&i'! prorrenina %n l!/ 7l*l!/ *&!,l"-%r*l!r%/ (% l"/ ri<"n%/ => L!/ /"n -i"i&"/ li/"/ -"(i)i!("/ /i&*!("/ %n l!/ p!r%(%/ (% l!/ !r&%ri"l!/ !)%r%n&%/ pr"i-!l%/ ! l"/ ,l"-7r*l"/ *!n(" (%/i%n(% l! pr%/i+n /% inii! *n! /%ri% (% r%!i"n%/ p!r! "n&r"l!rl! 1 Pr"(*i+n (% r%nin! =%ni-!> p"r %l ri<+n 2 L! r%nin! !&! /"#r% *n! ,l"#*lin! (%n"-in!(! /*/&r!&" (% r%nin! " !n,i"&%n/in+,%n" 3 %l !n,i"&%n/in+,%n" li#%r! l! !n,i"&%n/in! I .*% p%r-!n%%r5 pr"(*i7n("/% (*r!n&% 30-in =l" .*% (%-"r! l! r%nin! %n %l *%rp"> 4 L! !n,i"&%n/in! I %/ !&!li!(! p"r l! %ni-! "n'%r&i("r! (% !n,i"&%n/in! .*% %/&5 pr%/%n&% %n %l %n("&%li" (% l"/ '!/"/ p*l-"n!r%/ p!r! "n'%r&ir/% %n !n,i"&%n/in! II F L! !n,i"&%n/in! II %/ *n! /*/&!ni! '!/""n/&ri&"r! -* p"&%n&% p"r l" .*% p%r(*r! %n %l "r,!ni/-" (% 12 -in %/ (%/!&i'!(! p"r !n,i"&%n/in!/!/ D*r!n&% l! pr%/%ni! (% !n,i"&%n/in! II l! '!/""n/&rii+n %n l!/ !r&%ri"l!/ %n -%n"r p!r&% (% l!/ '%n!/ !*-%n&! l! pr%/i+n !r&%ri!l p"r "n/%*%ni! (%l !*-%n&" (% l! r%/i/&%ni! p%ri)7ri! &"&!l %n '%n! !*-%n&! %l r%&"rn" '%n"/" l%'%-%n&% l" .*% &!-#i7n "n&ri#*% !l !*-%n&" (% l! pr%/i+n A(%-5/ %l (%/%n/" (% l! %r%i+n &!n&" (% /!l "-" (% !,*! p"r l"/ ri<"n% / !*-%n&! l%n&!-%n&% %l l.*i(" %&r!%l*l!r l",r! !*-%n&!r l! pr%/i+n !r&%ri!l ! l!r," pl!" (*r!n&% "r!/ (!/
L! r!pi(% % in&%n/i(!( (% l! r%/p*%/&! (%l /i/&%-! r%nin!!n,i"&%n/in! %/ /*)ii%n&%-%n&% p"&%n&% p!r! (%'"l'%r l! pr%/i+n !r&%ri!l !l -%n"/ %n JF--H, /i%n(" l! n"r-!l 100--H, (%/p*7/ (% /*)rir *n! %-"rr!,i! i-p"r&!n&% D%-"/&r!n(" /* !p!i(!( r%,*l!&"ri! E@ECTO DE LA ANIOTEN?INA II EN LO? RIÑONE? L! !n,i"&%n/in! II p%r-i&% l! r%&%ni+n (% /!l !,*! %n l"/ ri<"n%/ (% ("/ -!n%r!/ 1 A&! (ir%&!-%n&% /+l" %n l"/ ri<"n%/ pr"'"!n(" l! r%&%ni+n 2 Pr"'"! l! /%r%i+n (% !l("/&%r"n! (% l!/ ,l5n(*l!/ /*pr!rr%n!l%/ l! !l("/&%r"n! pr"'"! l! r%!#/"ri+n (% /!l !,*! (% l"/ &#*l"/ r%n!l%/ M%!ni/-" (% l"/ %)%&"/ r%n!l%/ (ir%&"/ p"r !n,i"&%n/in! II A&! "n&r!%n(" l!/ !r&%ri"l!/ r%n!l%/ "n l" .*% (i/-in*% %l )l*$" /!n,*n%" ! &r!'7/ (% l"/ ri<"n%/ El )l*$" l%n&" (% /!n,r% r%(*% l! pr%/i+n p%ri&*#*l!r %/" p%r-i&% l! r%!#/"ri+n (% l.*i(" (%/(% l"/ &#*l"/ Di/-in*%n(" l! pr"(*i+n (% "rin! *n! .*in&! p!r&% (% l" n"r-!l E/&i-*l!i+n (% l! pr"(*i+n (% !l("/&%r"n! p"r !n,i"&%n/in! II L! %/&i-*l!i+n (% l!/ ,l5n(*l!/ /*pr!rr%n!l%/ p%r-i&% p"r !n,i"&%n/in! II pr"'"! l! pr"(*i+n (% !l("/&%r"n! .*% "n&ri#*% %n l! !#/"ri+n (% l.*i("/ %n l"/ &#*l"/ r%n!l%/ p"r l" .*% !*-%n&! %l /"(i" %n %l l.*i(" %&r!%l*l!r E/&" pr"'"! r%&%ni+n (ri! "n /* "n/%*%n&% !*-%n&" (% pr%/i+n !r&%ri!l @KNCION DEL ?I?TEMA RENINAANIOTEN?INA EN EL MANTENIMIENTO DE LA PRE?IN ARTERIAL ?I HA RANDE? INE?TIONE? DE ?AL El /i/&%-! RA? p%r-i&% %l "n&r"l (% l! pr%/i+n !r&%ri!l /i l! p%r/"n! in,i%r% p"!/ " ,r!n(%/ !n&i(!(%/ (% /!l (%l /i,*i%n&% -"(" 1 A*-%n&" (% l! in,%/&! (% /!l 2 A*-%n&" (%l '"l*-%n %&r!%l*l!r 3 A*-%n&" (% l! pr%/i+n !r&%ri!l .*% !*-%n&! %l )l*$" /!n,*n%" ! &r!'7/ (% l"/ ri<"n%/ r%(*i%n(" l! /%r%i+n (% r%nin! l! "n/%*%n&% r%&%ni+n (% /!l !,*! 4 R%&"rn" (%l l.*i(" %&r!%l*l!r ! l! n"r-!li(!( F R%&"rn" (% l! pr%/i+n !r&%ri!l ! l! n"r-!li(!( MEDICAMENTO? KE ACTKAN BLOKEANDO EL ?I?TEMA RENINA ANIOTEN?INA
L! )!-ili! (% )5r-!"/ ini#i("r%/ (% l! %ni-! "n'%r&i("r! =IECA> /"n !,%n&%/ ip"&%n/"r%/ "n *n! %)i!i! .*% r"n(! %l J0 %n ("/i/ -5i-! ?* -%!ni/-" (% !i+n /% #!/! %n l! in&%rr*pi+n (% l! /n&%/i/ (% !n,i"&%n/in! II "n l" *!l /% pr%'i%n% %l %)%&" '!/""n/&ri&"r l! /%r%i+n (% !l("/&%r"n! T!-#i7n (%#% -%ni"n!r/% /* %)%&" n!&ri*r7&i" .*% "-pl%-%n&! %l %)%&" !n&iip%r&%n/i'" E/ %)i! ! l!r," pl!" %n l! r%'%r/i+n (% ip%r&r")i! '%n&ri*l!r i.*i%r(! !/ "-" l! r%(*i+n (% l! pr"&%in*ri! /* !i+n pr"&%&"r! r%n!l n" /+l" %n p!i%n&%/ (i!#7&i"/ /in" &!-#i7n %n ip%r&%n/"/ %/%ni!l%/ "n -ir"!l#*-in*ri! L"/ IECA !*-%n&!n l! !i+n (%l /i/&%-! (% l!/ !lir%in!/.*inin!/ "n !*-%n&" (% l! /n&%/i/ (% pr"/&!,l!n(in!/ '!/"(il!&!("r!/ n!&ri*r7&i!/ =Pr"/&!ilin! PE2> P%/% ! .*% l"/ IECA /"n !l&!-%n&% %)i!%/ %n l"/ p!i%n&%/ "n %l /i/&%-! r%nin! !n,i"&%n/in! !&i'!(" /% ! "#/%r'!(" .*% /"n !p!%/ (% r%(*ir l"/ '!l"r%/ (% pr%/i+n !r&%ri!l %n /*$%&"/ "n ni'%l%/ pl!/-5&i"/ (% r%nin! n"r-!l " #!$! Ell" /% (%#%r! ! l! p"&%ni!i+n (%l %)%&" (% l!/ .*inin!/ /* "n/%*%n&% %)%&" %/&i-*l!n&% (% l! !i+n '!/"(il!&!("r! (% l!/ pr"/&!,l!n(in!/ ,%n%r!i+n (% +i(" n&ri"
ANTAONI?TA? DE ANIOTEN?INA II
?"n (r",!/ "n pr"pi%(!(%/ (% !n&!,"ni/-" %/p%)i" (%l r%%p&"r AT1 C"n /* !(-ini/&r!i+n l! /*pr%/i+n (% l! r%&r"!li-%n&!i+n n%,!&i'! (% !n,i"&%n/in! II /"#r% l! /%r%i+n (% r%nin! pr"(*% *n !*-%n&" (% l! !&i'i(!( (% r%nin! pl!/-5&i! (% An, II ! p%/!r (% %ll" /% -!n&i%n% l! !&i'i(!( !n&iip%r&%n/i'! l! (i/-in*i+n (% l! "n%n&r!i+n (% !l("/&%r"n! /7ri! in(i!n(" %l %)ii%n&% #l".*%" (%l r%%p&"r (% An, II =AT1> El #".*%" (% l"/ r%%p&"r%/ AT1 (% -!n%r! (ir%&! !*/! '!/"(il!&!i+n r%(*% l! /%r%i+n (% l! '!/"pr%/in! r%(*% l! pr"(*i+n /%r%i+n (% !l("/&%r"n! %n&r% "&r!/ !i"n%/ El %)%&" "-#in!(" %/ *n! r%(*i+n %n l! pr%/i+n !r&%ri!l L"/!r&!n ! /i(" %l pri-%r !n&!,"ni/&! (% AT1 (%/!rr"ll!(" E/ %l -5/ %&%n/!-%n&% %/&*(i!(" %n /*/ pr"pi%(!(%/ %n "-p!r!i"n%/ "n "&r"/ !n&iip%r&%n/i'"/ L"/ n*%'"/ !n&!,"ni/&!/ (% AT1 p"/%%n *n! -!"r p"&%ni! %)i!i! .*% %l L"/!r&!n>
TIPOS DE #IPERTENSIÓN EN QUE INTERVIENE ANGIOTENSINA En "!/i"n%/ !p!r%% *n &*-"r (% l!/ 7l*l!/ *&!,l"-%r*l!r%/ /%r%&"r!/ (% r%nin! .*% /%,r%,! ,r!n(%/ !n&i(!(%/ (% r%nin! l! "n/%*%n&% )"r-!i+n (% !n,i"&%n/in! 2 ,%n%r!n(" ip%r&%n/i+n ! l!r," pl!" Hip%r&%n/i+n (% "l(#l!&& "n ri<+n ni" C*!n(" /% %li-in! *n ri<+n /% r%!li! "-pr%/i+n %n l! !r&%ri! r%n!l in-%(i!&!-%n&% !% l! pr%/i+n (% (i! !r&%ri! (%/p*7/ (% *n"/ /%,*n("/ l! pr%/i+n /i/&7-i! "-i%n! ! !*-%n&!r (*r!n&% '!ri"/ (!/ (*r!n&% %/% &r!n/*r/" l! pr%/i+n %n l! !r&%ri! r%n!l !#r5 '*%l&" ! l! n"r-!li(!(
Hip%r&%n/i+n (% "l(#l!&& "n ("/ ri<"n%/ El ri<+n .*% &i%n% l! "n/&rii+n /%,r%,! r%nin! &!-#i7n r%&i%n% /!l !,*! p"r %l (%/%n/" (% !,*! p"r %l (%/%n/" (% l! pr%/i+n !r&%ri!l (% %/% ri<+n %l ri<+n n"r-!l r%&i%n% /!l !,*! p"r l! pr%/%ni! (% r%nin! pr"(*i(! p"r %l ri<+n i/.*7-i" L! r%nin! pr"'"! l! )"r-!i+n (% !n,i"&%n/in! II !l("/&%r"n! ir*l!n(" !i! %l ri<+n "n&r!ri" !i%n(" .*% r%&%n,! /!l !,*! C!*/!(" ip%r&%n/i+n p"r ("/ -"&i'"/ (i)%r%n&%/ Hip%r&%n/i+n p"r ri<"n%/ %n)%r-%-"/ C*!n(" %/&" /*%(% %l &%$i(" r%n!l i/.*7-i" /%,r%,! r%nin! .*% )"r-! !n,i"&%n/in! II r%&%ni%n(" !,*! /!l
OTROS TIPOS DE #IPERTENSIÓN PROVOCADA POR SOBRECARGA DE VOLUMEN Y VASOCONSTRICCIÓN •
•
Hip%r&%n/i+n %n l! p!r&% !l&! (%l *%rp" p"r "!r&!i+n !+r&i! Bl".*%" (% l! !"r&! %n *n p*n&" (i/&!l ! l! !#%! #r!"/ pr"i-!l ! l!/ !r&%ri!/ r%n!l%/ *!n(" /% pr"'"! "n/&rii+n p"r %ni-! (% l!/ !r&%ri!/ r%n!l%/ #!$! l! pr%/i+n (% l"/ ri<"n%/ /% /%,r%,! r%nin! !*-%n&" (% pr%/i+n !r&%ri!l %n l! p!r&% in)%ri"r !*-%n&! !/&! l! n"r-!li(!( p%r" l! p!r&% /*p%ri"r !*-%n&! !*/!n(" ip%r&%n/i+n Hip%r&%n/i+n %n l! pr%%l!-p/i! =&"%-i! (%l %-#!r!"> ?% r%% /%! p"r l! i/.*%-i! (% l! pl!%n&! .*% pr"(*% l! li#%r!i+n (% )!&"r%/ &+i"/ .*% !*/!n l! (i/)*ni+n (% l!/ 7l*l!/ %n("&%li!l%/ (i/-in*%n(" l! li#%r!i+n
(% +i(" n&ri" (% "&r!/ /*/&!ni!/ '!/"(il!&!("r!/ (%/%n/" %n l! )il&r!i+n (% l.*i("/ !l&%r!i+n (% l! n!&ri*r%/i/ pr"'"!n(" ip%r&%n/i+n •
Hip%r&%n/i+n n%*r+,%n! ?% (%#% ! l! %/&i-*l!i+n p"&%n&% (%l /i/&%-! n%r'i"/" /i-p5&i" pr"'"!n(" '!/""n/&rii+n p%ri)7ri! Pr"'"!(! p"r #!r"rr%%p&"r%/ L! in&%rr*pi+n #r*/! (% l!/ /%
•
Hip%r&%n/i+n pri-!ri! =%/%ni!l> %/ (% &ip" (%/"n"i(" /"n /%*n(!ri!/ ! !*/!/ "n"i(!/ El !*-%n&" (% p%/" l! 'i(! /%(%n&!ri! p!r%% (%/%-p%
Tr!&!-i%n&" (% l! ip%r&%n/i+n %/%ni!l ?% r%"-i%n(! -"(i)i!r %l %/&il" (% 'i(! !*-%n&!n(" %l %$%rii" p!r! !*(!r ! l! p7r(i(! (% p%/" %l */" (% )5r-!"/ !n&iip%r&%n/i'"/ 1 @5r-!"/ '!/"(il!&!("r%/ .*% !*-%n&%n %l )l*$" /!n,*n%" r%n!l 2 @5r-!"/ n!&ri*r7&i"/ " (i*r7&i"/ .*% (i/-in*%n l! r%!#/"ri+n &*#*l!r (% /!l !,*! L"/ )5r-!"/ '!/"(il!&!("r%/ pr"'"!n (il!&!i+n %n &%$i("/ ini#i%n(" l!/ /%
L"/ )5r-!"/ .*% r%(*%n l! !#/"ri+n #l".*%!n %l &r!n/p"r&% !&i'" (% /"(i" ! &r!'7/ (% l! p!r%( &*#*l!r ! /* '% %/&% #l".*%" pr%'i%n% l! r%!#/"ri+n (% !,*! @RMACO? NATRIKRETICO L"/ P7p&i("/ N!&ri*r7&i"/ =PN> /"n "r-"n!/ (% n!&*r!l%! pr"&%i! li#%r!(!/ prinip!l-%n&% p"r l!/ 7l*l!/ -i"5r(i!/ (% l"/ !&ri"/ '%n&r*l"/ %n r%/p*%/&! ! *n! /"#r%!r,! (% '"l*-%n " !l !*-%n&" (% l!/ pr%/i"n%/ in&r!!'i&!ri!/1 Ti%n%n pr"pi%(!(%/ (i*r7&i!/ '!/"(il!&!("r!/ ?* %/&*(i" /% ! %n!-in!(" !l (i!,n+/&i" &r!&!-i%n&" (% l!/ !r(i"p!&!/ 2 •
P7p&i(" n!&ri*r7&i" &ip" A
El ANP %/ *n! "r-"n! p"lip%p&(i! li! "-p*%/&! p"r 28 !-in"5i("/ /in&%&i!(! /%r%&!(! prinip!l-%n&% p"r l!/ !*r*l!/ %n %l "r!+n !(*l&" n"r-!l ?% !l-!%n! %n )"r-! (% ,r5n*l"/ "-" pr""r-"n! =pr"ANP> C*!n(" /% /%,r%,! %/ (i'i(i(! p"r *n! pr"&%!/! =!n&i(!(%/ %.*i-"l!r%/> %n *n )r!,-%n&" &%r-in!l (% 98 !-in"5i("/ =NTpr"ANP> l! -"l7*l! #i"l+,i!-%n&% !&i'! =ANP> El ANP %/ r5pi(!-%n&% %&r!(" (% l! ir*l!i+n prinip!l-%n&% !l *nir/% ! l"/ r%%p&"r%/J -%(i!n&% i(r+li/i/ p"r *n! %n("p%p&i(!/! n%*&r! D%#i(" ! .*% %l NTpr"ANP %/ -%n"/ '!ri!#l% &i%n% *n! 'i(! -%(i! -5/ l!r,! (%n&r" (%l /i/&%-! ir*l!&"ri" p!r%% /%r *n -%$"r -5/ r%pr%/%n&!&i'" -!r!("r (% /"#r%!r,! !r(i!! .*% %l ANP •
P7p&i(" n!&ri*r7&i" &ip" B
El BNP %/ *n p7p&i(" (% 32 !-in"5i(" %/&r*&*r!l-%n&% /i-il!r !l ANP C"n&i%n% *n! %/&r*&*r! ir*l!r "-p*%/&! p"r 1J !-in"5i("/ "-n ! &"("/ l"/ p7p&i("/ n!&ri*r7&i"/ El BNP %/ /in&%&i!(" "-" *n! pr""r-"n! pr"BNP =108 !-in"5i("/> %l *!l %/ (%/"-p*%/&" p"r *n! )*rin! %n l!/ -"l7*l!/ !&i'! =BNP> % in!&i'! =NTpr"BNP> T!n&" %l pr"BNP "-" %l BNP NT pr"BNP p*%(%n %/&!r pr%/%n&%/ %n %l -i"!r(i" %l pl!/-! El pr"%/" (% (%/"-p"/ii+n p!r%% .*% /% r%!li! %n %l -i"!r(i" El BNP %/ -5/ %/&!#l% .*% %l ANP %n %l pl!/-! &i%n% *n! 'i(! -%(i! -5/ l!r,! =22 -in> l" .*% p*%(% /%r !&ri#*i(" ! /* -%n"r !)ini(!( p"r l"/ r%%p&"r%/ ! l! %n("p%p&i(!/! n%*&r! L! 'i(! -%(i! (%l NTpr"BNP %/ (% J0 -in *n!/ 1F '%%/ -!"r .*% %l BNP P!r%% /%r *n -!r!("r -5/ /%n/i#l% (% (i/)*ni+n '%n&ri*l!r i.*i%r(! .*% %l BNP A*n.*% %l BNP )*% (%/*#i%r&" "ri,in!ri!-%n&% %n %l %r%#r" l!/
"n%n&r!i"n%/ (% p7p&i(" BNP %l ARN- /"n -!"r%/ %n l!/ !*r*l!/ %n l"/ '%n&r*l"/ P7p&i(" n!&ri*r7&i" &ip" C El CNP "n&i%n% 22 !-in"5i("/ %/ pr"(*i(" p"r %l %n("&%li" '!/*l!r &i%n% %)%&"/ '!/"(il!&!("r%/ !n&i pr"li)%r!&i'"/ %n %l -/*l" li/" '!/*l!r Ti%n% *n! !i+n l"!l %n l"/ '!/"/ /!n,*n%"/ %n %l in&%ri"r (% l"/ +r,!n"/ ("n(% /% pr"(*% L! %/&r*&*r! l!/ pr"pi%(!(%/ )i/i"l+,i!/ (%l CNP /"n /i-il!r%/ ! l!/ (% l!/ "r-"n!/ !r(i!!/ ANP BNP p%r" p"" /% "n"% /"#r% /* p!p%l )i/i"p!&"l+,i" %n l! in/*)ii%ni! !r(i!! r+ni! R%i%n&%-%n&% /% ! (%/*#i%r&" .*% %l CNP %/ !p! (% /%r /in&%&i!(" p"r %l -i"!r(i" !l "-pr"#!r l!/ (i/&in&!/ "n%n&r!i"n%/ %n l! r! !+r&i! %l /%n" "r"n!ri" %n p!i%n&%/ "n in/*)ii%ni! !r(i!! P"r %ll" /% r%% .*% 7/&% p"(r! /%r *n n*%'" % i-p"r&!n&% -%(i!("r l"!l %n %/&"/ p!i%n&%/ @RMACO? DIKRETICO? ?%,*ril l! )*r"/%-i(! l! &"r!/%-i(! l!/ &i!i(!/ /"n l"/ (i*r7&i"/ -5/ )r%*%n&%-%n&% *&ili!("/ %n l! In/*)ii%ni! C!r(i!! L"/ (i*r7&i"/ !%n .*% %l p!i%n&% pr"(*! *n! -!"r !n&i(!( (% "rin! P"r l! "rin! /% %li-in!n %l !,*! %l /"(i" =l! /!l> %l p"&!/i" "&r!/ /*/&!ni!/ L",r!n !/ r%(*ir l! r%&%ni+n (% l.*i("/ %n %l *%rp" p"r l" .*% /"n &il%/ p!r! !li'i!r l! (i)i*l&!( p!r! r%/pir!r l! in!+n (% l!/ pi%rn!/ %n l"/ p!i%n&%/ "n in/*)ii%ni! !r(i!! ?"n !/i-i/-" %)i!%/ p!r! (i/-in*ir l! &%n/i+n !r&%ri!l Ei/&%n (i)%r%n&%/ &ip"/ (% (i*r7&i"/ (i*r7&i"/ (% !/! =)*r"/%-i(! &"r!/%-i(!> &i!i(!/ =i(r"l"r"&i!i(! %n&r% "&r"/> (i*r7&i"/ !"rr!("r%/ (% p"&!/i" =%/pir"n"l!&"n! %pl%r%n"n! !-il"ri(%> L"/ ("/ pri-%r"/ ,r*p"/ !*-%n&!n l! p7r(i(! (% p"&!/i" p"r l! "rin! =p"r l" .*% (i/-in*% %n l! /!n,r%> -i%n&r!/ .*% l"/ (i*r7&i"/ !"rr!("r%/ (% p"&!/i" l! (i/-in*%n =!*-%n&!n(" %n /!n,r%> p"r l" .*% %l -7(i" p*%(% /"lii&!r !n!l&i!/ p%ri+(i!-%n&% p!r! /* "n&r"l En !/" (% .*% l"/ ni'%l%/ (% p"&!/i" /%!n (%-!/i!(" #!$"/ ! '%%/ %/ n%%/!ri" &"-!r p!/&ill!/ (% /*pl%-%n&"/ (% p"&!/i" ANTIDIKRETICO? M!ni&"l I/"/"r#i(% ,li%rin! %&r!%n !,*! (%l l.*i(" in&r!%l*l!r %p!n(%n %l l.*i(" %&r!%l*l!r (i/-in*%n l! 'i/"/i(!( /!n,*n%! !*-%n&!n %l @?R pr"(*%n Ql!'!(" "/-+&i"Q (i*r%/i/ !*"/! i-pi(% l! r%!#/"ri+n %n l*,!r%/ p%r-%!#l%/ !l !,*! (i/-in*%n %l '"l*-%n &i/*l!r
