la extinción del mayor dinosaurio ¿el fin de la cardiopatía hipertensiva? · 2020. 11. 25. ·...

La extincion del mayor

dinosaurio... ¿El fin de la

cardiopatia hipertensiva? Dr. Juan Jose Gomez Doblas.

H .U. Virgen de la Victoria. Malaga

CIBERCV. UMA

IC PRESERVADA

N Engl J Med 2006; 355:251-259

IC PRESERVADA

Prevalencia HTA España – Estudio Darios

M. Grau et al / Rev Esp Cardiol. 2011;64(4):295–304

CARACTERISTICAS DE LOS

PACIENTES CON IC CON FUNCION

SISTOLICA PRESERVADA

Circ Heart Fail. 2018;11:e004962. DOI: 10.1161/CIRCHEARTFAILURE.118.004962

REGISTRO RICA. FACTORES DE RIESGO

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Failure. JAMA: The Journal of the American Medical Association, 275(20), 1557.

PARAGON HF. CRITERIO DE INCLUSION

Progresion desde HTA a Insuficiencia

Cardiaca

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HFpEF. IC funcion

sistolica preservada

Progresion desde HTA a Insuficiencia Cardiaca

Hypertension. 2019;74:1357–1365

Pronotico de HTA e Insuficiencia Cardiaca

Hypertension. 2019;74:1357–1365

FISIOPATOLOGIA DEL CONTINUUM

CARDIOVASCULAR EN HTA

Arantxa Gonzalez et al. Hypertension. 2018;72:549–558

Current Pharmaceutical Design, 2018, 24, 4391-4396

DIAGNOSTICO CARDIOPATIA HIPERTENSIVA

Díez J, Mechanisms of disease: pathologic structural remodeling is more than adaptive hypertrophy in hypertensive heart disease. Nat Clin Pract Cardiovasc Med. 2005;2:209-216

A: Perivascular fibrosis; B: Microscopic scarring; C: Interstitial fibrosis.

Díez J. Mechanisms of cardiac fibrosis in hypertension. J Clin Hypertens (Greenwich). 2007;9:546-550.

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Cardiovasc Ultrasound. 2020; 18: 44.

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MagneticResonance Evaluation Differentiates Among

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Hypertensive Patients, andHealthy Control Subjects

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Tratamiento

• HETEROGENEIDAD

• COMORBILIDAD

• DIFERENTES ESTADIOS DE LA

ENFERMEDAD

• AUSENCIA DE TRATAMIENTOS

PARA ICp

HFpEF. IC funcion

sistolica

preservada

CHARM

preserved

Yusuf, SJ. (2003). Effects of candesartan

in patients with chronic heart failure and

preserved left-ventricular ejection

fraction: the CHARM-Preserved Trial. The

Lancet, 362(9386), 777–781.

Nat Rev Cardiol 2020 Sep;17(9):559-573.

Spironolactone

Placebo

HR = 0.89 (0.77 – 1.04)

p=0.138

351/1723 (20.4%)

320/1722 (18.6%)

1°Outcome (CV Death, HF Hosp, or Resuscitated Cardiac Arrest) N Engl J Med. 2014;1383–1392

HR =

Spironolactone

Placebo

HR = 0.83 (0.69 – 0.99)

p=0.042

245/1723 (14.2%)

206/1722 (12.0%)

Heart Failure Hospitalizations N Engl J Med. 2014;1383–1392

Tratamiento

Current Pharmaceutical Design, 2018, 24, 4391-4396

Fenotipos de

IC con

funcion

sistolica

preservada

Klingbeil AU, Schneider M, Martus P, Messerli FH, Schmieder RE. A

meta-analysis of the effects of treatment on left ventricular mass in

essential hypertension. Am J Med. 2003;115:41-46.