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

1. HTA y enfermedad coronaria
Almudena Castro Conde
Hospital Universitario La Paz
Unidad Rehabilitación Cardiaca

2. J Am Coll Cardiol 2016;68:1713–22

4. 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

5. J Am Coll Cardiol 2016;68:1723-1726

6. J Am Coll Cardiol 2016;68:1713–22

7. J Am Coll Cardiol 2016;68:1713–22

8. J Am Coll Cardiol 2016;68:1723-1726

9. The Lancet, Vol. 387, No. 10022, p957–967
TAS < 130 mm Hg

10. N Engl J Med 2015;373:2103-16
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
The SPRINT Research Group*

11. Objetivo del estudio

12. 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

13. 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

14. Lancet 2016; 388: 2142–52

15. Lancet 2016; 388: 2142–52

16. 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

17. 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:

18. The American Journal of Medicine (2016) 129, 372-378

19. The American Journal of Medicine (2016) 129, 372-378
Objetivo TA

20. 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

21. Conclusiones:
• Objetivo de TA 130-139/80-89 mm Hg
• TAD < 60 mm Hg
• Tx HTA: BB / IECASo ARA II/ Diuréticos