40 Boletín Hipertensión VOL 26. 2025 / 38 - 41 Antihipertensivos en la mujer Finalmente, las mujeres con HTA tienen un mayor riesgo de sufrir reacciones adversas a los fármacos antihipertensivos (hasta un 50 % más que los pacientes varones). Las pacientes hipertensas tienen significativamente más probabilidades de presentar tos con el uso de los inhibidores de la enzima convertidora y de edema con los bloqueadores de canales de calcio (38,39). Además, al utilizar tiazidas exhiben un mayor riesgo de experimentar hipokalemia e hiponatremia, lo que exige un seguimiento más atento con exámenes de laboratorio (40). Es importante enfatizar que esta mayor susceptibilidad a tener efectos adversos, no debe llevar al clínico a la inercia terapéutica puesto que los beneficios del control de la presión arterial en las mujeres hipertensas son iguales o incluso superiores a los de su contraparte masculina (Tabla 2). Mujeres en edad fértil: considerar amlodipino +/- betabloqueador excepto atenolol ; usar por ejemplo bisoprolol o metoprolol Considerar diuréticos tiazídicos dada la mayor sensibilidad al Na+ (asociado a iRAS) En mujeres con obesidad considerar adición de antagonista del receptor mineralocorticoide En mujeres con S.O.P. considerar iRAS + espironolactona En mujeres que han tenido un S.H.E. efectuar seguimiento cuidadoso de la P.A. y F. de R. C.V. Considerar que tienen un mayor riesgo de RAM por antihipertensivos (¡pero evitar inercia terapéutica!) Tabla 2. Recomendaciones terapéuticas farmacológicas a considerar en la mujer hipertensa. (Abreviaturas: iRAS: inhibidor del sistema renina angiotensina; HTA: hipertensión; R: receptor; S.O.P.: síndrome de ovarios poliquísticos; S.H.E.: síndrome hipertensivo del embarazo; P.A.: presión arterial; F. de R. C.V.: factores de riesgo cardiovascular; RAM: reacción adversa a medicamento). Referencias 1. 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