Paciente con insuficiencia cardiaca y HTA

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Visión multidisciplinar del control de HTA
23/11/16 18:30h Casa del Corazón, Madrid
http://controlhta.secardiologia.es
#controlHTA

Paciente con insuficiencia cardiaca y HTA
Dr. Domingo Marzal Martín, Complejo Hospitalario de Mérida (Badajoz)
@domingomarzal

Publicado en: Salud y medicina
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Paciente con insuficiencia cardiaca y HTA

  1. 1. Madrid, noviembre 2016 Domingo Marzal Martín Visión multidisciplinar del control de la HTA HTA & INSUFICIENCIA CARDIACA
  2. 2. Bhatia RS, et al. N Engl J Med. 2006;355:260-9 Heart failure risks factors
  3. 3. Farmer C, et al. BMJ. 2016;354:i4843 Multimorbidity
  4. 4. SPRINT Investigators. N Engl J Med. 2015;373:2103-16
  5. 5. Vidal-Petiot E, et al. Lancet 2016;388:p2142–52 Systolic blood pressure Diastolic blood pressure CV death, MI or stroke
  6. 6. Systolic blood pressure Diastolic blood pressure Vidal-Petiot E, et al. Lancet 2016;388:p2142–52 Hospital admission for heart failure
  7. 7. Heart Failure HR 0.36 (0.22-0.58) P<0.001 Beckett NS, et al. N Engl J Med. 2008;358:1887-98 Death from Any Cause HR 0.79 (0.65-0.95) P=0.02
  8. 8. <140/90 mmHg ≈130/80 mmHg Ponikowski P, et al. Eur Heart J. 2016;37:2129-200
  9. 9. Turnbull F, et al. Lancet 2003;362:1527–35
  10. 10. Turnbull F, et al. Lancet 2003;362:1527–35
  11. 11. Turnbull F, et al. Lancet 2003;362:1527–35
  12. 12. HFrEF vs. HFpEF
  13. 13. HFrEF
  14. 14. Ponikowski P, et al. Eur Heart J. 2016;37:2129-200 Therapeutic algorithm HFrEF symptomatic (NYHA Class II-IV)
  15. 15. Ponikowski P, et al. Eur Heart J. 2016;37:2129-200 ACE inhibitors Study Drug Symptoms Results (RRR) CONSENSUS N Engl J Med. 1987;316:1429-35 Enalaprilo Severe Mortality 27% SOLVD N Engl J Med. 1991;325(5):293-302 Enalaprilo Mild- moderate Mortality 16% Hospitalization 26% SOLVD Prevention Trial N Engl J Med. 1992;327:685-91 Captoprilo Asymptomatic post-MI Mortality/ HF hospitalization 20% SAVE N Engl J Med. 1992;327:669-77 Captoprilo Mortality 26% Mortality/ HF hospitalization 27% AIRE Lancet. 1993;342:821-8 Ramiprilo TRACE N Engl J Med. 1995;333:1670-6 Trandolaprilo
  16. 16. Ponikowski P, et al. Eur Heart J. 2016;37:2129-200 Beta-blockers Study Drug Symptoms Results (RRR – first year treatment) CIBIS II Lancet. 1999;353:9-13 Bisoprolol Mild- moderate Mortality 34% HF hospitalization 28-36% MERIT-HF Lancet. 1999;353:2001-7 Metoprolol CR/XL COPERNICUS Circulation. 2002;106:2194-9 Carvedilol Severe >90% patients under treated with ACEI or ARB
  17. 17. Ponikowski P, et al. Eur Heart J. 2016;37:2129-200 aPitt B, et al. N Engl J Med. 1999;341:709-17 bZannad F, et al. N Engl J Med. 2011;364:11-21 HR 0.70 (0.60-0.82) P<0.001 Survivalprobability Spironolactone Placebo 1,00 0,40 0,90 0,80 0,70 0,60 0,50 0 6 12 18 24 30 36 Months RALESa 100 0 60 50 40 30 20 10 0 1 2 3 Eplerenone Placebo Years CVmortalityor HFhospitalization(%) EMPHASIS-HFb HR 0,63 (0,54-0,74) P<0,0001
  18. 18. HF Guideline ESC 2016 I Class A Level Marzal D; et al. Proceso Asistencial Simplificado IC SEC 2016
  19. 19. Marzal D; et al. Proceso Asistencial Simplificado IC SEC 2016 HF Guideline ESC 2016 I Class C Level
  20. 20. Marzal D; et al. Proceso Asistencial Simplificado IC SEC 2016HF Guideline ESC 2016 I Class A Level
  21. 21. HFpEF
  22. 22. Yancy CW, et al. J Am Coll Cardiol. 2013;62:e147-239
  23. 23. Ponikowski P, et al. Eur Heart J. 2016;37:2129-200 Treatment HFpEF & HFmrEF
  24. 24. Marzal D; et al. Proceso Asistencial Simplificado IC SEC 2016
  25. 25. Ponikowski P, et al. Eur Heart J. 2016;37:2129-200 Recommendations for the treatment of hypertension in symptomatic (NYHA Class II-IV) HFrEF
  26. 26. Outcomes trials in HFpEF HR=0.95 (0.86-1.05) P=0.35 I-PRESERVEc Months Primaryoutcome(%) CHARM-Preserveda HR=0.89 (0.77-1.03) P=0.118 CVdeathor admissionforCHF(%) Years Deathor HFhospitalization(%) Years HR=0.92 (0.70-1.21) P=0.545 PEP-CHFb aYusuf S, et al. Lancet 2003;362:777–81 bCleland JG, et al. Eur Heart J. 2006;27:2338-45 cMassie BM, et al. N Engl J Med 2008;359:2456-67 dPitt B, et al. N Engl J Med. 2014;370:1383-92 Spironolactone Placebo HR=0.89 (0.77–1.04) P=0.138 CV death, HF hospitalization or aborted cardiac arrest TOPCATd
  27. 27. Spironolactone Placebo HR=0.89 (0.77–1.04) P=0.138 351/1723 (20.4%) 320/1722 (18.6%) CV death, HF hospitalization or aborted cardiac arrest Pitt B, et al. N Engl J Med. 2014;370:1383-92 TOPCAT
  28. 28. Spironolactone Placebo HR=0.83 (0.69–0.99) P=0.042 245/1723 (14.2%) 206/1722 (12.0%) Heart failure hospitalization Pitt B, et al. N Engl J Med. 2014;370:1383-92 TOPCAT
  29. 29. Pitt B, et al. N Engl J Med. 2014;370:1383-92 P interaction=0.122 US, Canada, Argentina, Brazil HR=0.82 (0.69-0.98) Russia, Rep Georgia HR=1.10 (0.79-1.51) Placebo 31.8% Placebo 8.4% Exploratory (post-hoc) CV death, HF hospitalization or aborted cardiac arrest Spironolactone Placebo TOPCAT
  30. 30. Kosmala, W. et al. J Am Coll Cardiol. 2016;68:1823-34 STRUCTURE trial
  31. 31. Phenotype-specific HFpEF Shah SJ, et al. Circulation. 2016;134:73-90
  32. 32. Shah SJ, et al. Circulation. 2016;134:73-90
  33. 33. Shah SJ, et al. Circulation. 2016;134:73-90
  34. 34. take home messages
  35. 35. gracias por vuestra atención domingo.marzal@secardiologia.es @domingomarzal

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