Paciente con angina de esfuerzo y revascularización incompleta

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Visión multidisciplinar del control de HTA
23/11/16 18:30h Casa del Corazón, Madrid
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Paciente con angina de esfuerzo y revascularización incompleta
Dra. Almudena Castro Conde, Hospital Universitario La Paz (Madrid)
@almucastro01

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Paciente con angina de esfuerzo y revascularización incompleta

  1. 1. HTA y enfermedad coronaria Almudena Castro Conde Hospital Universitario La Paz Unidad Rehabilitación Cardiaca
  2. 2. J Am Coll Cardiol 2016;68:1713–22
  3. 3. Kjeldsen SE, et al. Blood Press 2016;25:83–92 Elliott HL, et al. Blood Press 2016;25:67–73 Messerli FH, et al. Ann Intern Med 2006;144:884–93 Bangalore S, et al. Eur Heart J 2010;31:2897–908 Curva en “J ”Sí NO
  4. 4. J Am Coll Cardiol 2016;68:1723-1726
  5. 5. J Am Coll Cardiol 2016;68:1713–22
  6. 6. J Am Coll Cardiol 2016;68:1713–22
  7. 7. J Am Coll Cardiol 2016;68:1723-1726
  8. 8. The Lancet, Vol. 387, No. 10022, p957–967 TAS < 130 mm Hg
  9. 9. N Engl J Med 2015;373:2103-16 A Randomized Trial of Intensive versus Standard Blood-Pressure Control The SPRINT Research Group*
  10. 10. Objetivo del estudio
  11. 11. 22.672 pacientes Objetivo 1º: Muerte CV IM no fatal Stroke no fatal Objetivo 2º: C/u Obj 1º Mortalidad total Ingresos IC SBP: <120, 120–129 (reference), 130–139, 140–149, and ≥150 mmHg DBP: <60, 60–115 69, 70–79 (reference), 80–89, and ≥90 mmHg Lancet 2016; 388: 2142–52
  12. 12. Restricted cubic splines ofmprimary outcome vs average SBP and DBP Hazard ratios for the composite of CV, death, MI or stroke Lancet 2016; 388: 2142–52
  13. 13. Lancet 2016; 388: 2142–52
  14. 14. Lancet 2016; 388: 2142–52
  15. 15. Lancet 2016; 388: 2142–52 – Serious non CV conditions were excluded from CLARIFY – The association between low SBP or DBP and CV events was robust and persisted despite adjustments, including HF, LVEF and baseline drugs, as well as in sensitivity analyses excluding patients with any Hx of HF – There was no association between low BP and stroke Arguments against reverse causality
  16. 16. Lancet 2016; 388: 2142–52 • In “real-life” stable CAD patients treated for hypertension:  low systolic (<120 mmHg) and low diastolic (<70 mmHg) BPs are associated with an increased risk of cardiovascular events, except stroke • This J-curve relationship between BP and adverse outcomes suggests caution in the use of BP-lowering treatment in CAD patients Conclusions:
  17. 17. The American Journal of Medicine (2016) 129, 372-378
  18. 18. The American Journal of Medicine (2016) 129, 372-378 Objetivo TA
  19. 19. Angina IECAS/ARA II DIUR BB CCA NO DHP CCA DHP ANT ALD Estable 1** 1*** 1* 2** 2* 2*** DSVI IAM previo Diabetes Proteinuria Bisoprolol Metoprolol Si CI a BB Diltiazem Amlodipino Felodipino HTA R DSVI IC HCTZ Clortalidona The American Journal of Medicine (2016) 129, 372-378 Fármacos de elección
  20. 20. Conclusiones: • Objetivo de TA 130-139/80-89 mm Hg • TAD < 60 mm Hg • Tx HTA: BB / IECASo ARA II/ Diuréticos

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