Differences between the 2013 and 2014 hypertension guidelines. Position of the Central American and Caribbean Society for Hypertension and Cardiovascular Prevention/ Divergencias entre guías de 2013 y 2014 de la hipertensión arterial. Posición de la Sociedad Centroamericana y del Caribe de Hipertensión y Prevención Cardiovascular

Between the end of 2013 and the beginning of 2014 the most internationally influential hypertension guidelines were published. Although there are no major differences between them, there are discrepancies that can have an impact on treatment and prognosis for individuals with hypertension. This article analyzes the main controversial elements in the guides and presents the recommendations of the Sociedad Centroamericana y del Caribe de Hipertension y Prevencion Cardiovascular (Caribbean Society for Hypertension and Cardiovascular Prevention). The main differences are found a) in the categorization of prehypertension, b) in the use of global cardiovascular risk in the decision to begin antihypertensive treatment, c) in the validity of beta-blockers as first-line drugs in treating uncomplicated hypertension, and d) the increase in the therapeutic goal of maintaining values between < 140/90 and < 150/90 mmHg in patients over 60 years of age with no history of diabetes or chronic kidney disease. All the factors in favor of and against accepting each of these four controversial criteria are analyzed critically and the observations made by the Society are included. The conclusion is that there are pros and cons for all controversial elements in the hypertension guides. However, the weight of the evidence and clinical judgment favor subdividing prehypertension into stages I and II, seeking a therapeutic goal of maintaining systolic blood pressure below 140 mmHg in all the hypertensive patients under 80 years of age, retaining beta-blockers as first-line drugs in uncomplicated hypertension, and not delaying the start of drug treatment for hypertension stage I with low global cardiovascular risk. Finally, seven recommendations by the Society based on the analysis are included. Key words Hypertension; risk factors; adrenergic beta-antagonists. Entre finales de 2013 y principios de 2014 se publicaron las guias de hipertension arterial (HTA) mas influyentes a nivel internacional. Aunque no existen grandes diferencias entre ellas, hay discrepancias que pueden repercutir en el tratamiento y el pronostico de las personas con hipertension. En este articulo se analizan los principales elementos polemicos de estas guias y se emiten las recomendaciones de la Sociedad Centroamericana y del Caribe de Hipertension y Prevencion Cardiovascular sobre el tema. Las principales divergencias se centran en la categoria de prehipertension arterial, el uso del riesgo cardiovascular globa