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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
Med Clin (Barc). 2020;xxx(xx):xxx–xxx
REGISTRO RICA. ETIOLOGIA
Med Clin (Barc). 2020;xxx(xx):xxx–xxx
Levy, D. (1996). The Progression From Hypertension to Congestive Heart
Failure. JAMA: The Journal of the American Medical Association, 275(20), 1557.
PARAGON HF. CRITERIO DE INCLUSION
Progresion desde HTA a Insuficiencia
Cardiaca
Circulation. 2011;123:327-334
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.
Journal of Cardiovascular Magnetic Resonance volume 14, Article number: 54 (2012)
Cardiovasc Ultrasound. 2020; 18: 44.
Comprehensive Echocardiographic and Cardiac
MagneticResonance Evaluation Differentiates Among
Heart Failure WithPreserved Ejection Fraction Patients,
Hypertensive Patients, andHealthy Control Subjects
J Am Coll Cardiol Img 2018;11:577–85I
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.