Evolución cardiovascular y cerebrovascular en ancianos hipertensos tratados con bloqueadores del receptor de angiotensina o con inhibidores de la enzima convertidora de angiotensina
Cardiovascular and cerebrovascular outcomes in elderly hypertensive patients treated with either ARB or ACEI.
Ma C, Cao J, Lu XC, Guo XH, Gao Y, Liu XF, Fan L.
The First Department of Geriatric Cardiology, South Building, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
J Geriatr Cardiol. 2012 Sep;9(3):252-7. doi: 10.3724/SP.J.1263.2011.12031.
Abstract
BACKGROUND: Although angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are equally important in the treatment of hypertension, there is less evidence whether they have equal cardiovascular and cerebrovascular protective effects, especially in elder hypertensive patients. This study aims to clarify this unresolved issue. METHODS: This cross-sectional study included clinical data on 933 aged male patients with hypertension who received either an ARB or ACEI for more than two months between January 2007 and May 2011. The primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary endpoints were unstable angina, new atrial fibrillation, and transient ischemic attack. RESULTS: The median follow-up time was 24 months. Age, drug types, cerebral infarction history, renal dysfunction history were the independent predictors of the primary endpoint. The risk of an occurrence of a primary endpoint event was higher in the ARB group than the ACEI group [P = 0.037, hazard ratios (HR): 2.124, 95% confidence interval (95% CI): 1.048-4.306]. The Kaplan-Meier method also suggests that the rate of primary endpoint occurrence was higher in the ARB group than the ACEI group (P = 0.04). In regard to the secondary endpoints, there were no significant differences between the two treatment arms (P = 0.137, HR: 1.454, 95% CI: 0.888-2.380). Patient age and coronary heart disease history were independent predictors of the secondary endpoint.
CONCLUSION: ACEI were more effective than ARB in reducing cardiovascular and cerebrovascular morbidity and mortality in aged patients with hypertension.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470024/pdf/jgc-09-03-252.pdf
Tratamiento de la hipertensión arterial sistémica
Treatment of systemic hypertension.
Aronow WS.
Cardiology Division, Department of Medicine, New York Medical College Valhalla, New York, USA.
Am J Cardiovasc Dis. 2012;2(3):160-70. Epub 2012 Jul 25.
Abstract
Systemic hypertension is a major risk factor for cardiovascular disease and is present in 69% of patients with a first myocardial infarction, in 77% of patients with a first stroke, in 74% of patients with chronic heart failure, and in 60% of patients with peripheral arterial disease. Double-blind, randomized, placebo-controlled trials have found that antihypertensive drug therapy reduces cardiovascular events in patients aged younger than 80 years and in patients aged 80 years and older in the Hypertension in the Very Elderly Trial. Although the optimal blood pressure treatment goal has not been determined, existing epidemiologic and clinical trial data suggest that a reasonable therapeutic blood pressure goal should be <140/90 mm Hg in patients younger than 80 years and a systolic blood pressure of 140-145 mm Hg if tolerated in patients aged 80 years and older. Non-pharmacologic lifestyle measures should be encouraged both to prevent development of hypertension and as adjunctive therapy in patients with hypertension. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, and diuretics have all reduced cardiovascular events in randomized trials. The choice of specific drugs depends on efficacy, tolerability, presence of specific comorbidities, and cost
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427981/pdf/ajcd0002-0160.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Cardiovascular and cerebrovascular outcomes in elderly hypertensive patients treated with either ARB or ACEI.
Ma C, Cao J, Lu XC, Guo XH, Gao Y, Liu XF, Fan L.
The First Department of Geriatric Cardiology, South Building, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
J Geriatr Cardiol. 2012 Sep;9(3):252-7. doi: 10.3724/SP.J.1263.2011.12031.
Abstract
BACKGROUND: Although angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are equally important in the treatment of hypertension, there is less evidence whether they have equal cardiovascular and cerebrovascular protective effects, especially in elder hypertensive patients. This study aims to clarify this unresolved issue. METHODS: This cross-sectional study included clinical data on 933 aged male patients with hypertension who received either an ARB or ACEI for more than two months between January 2007 and May 2011. The primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary endpoints were unstable angina, new atrial fibrillation, and transient ischemic attack. RESULTS: The median follow-up time was 24 months. Age, drug types, cerebral infarction history, renal dysfunction history were the independent predictors of the primary endpoint. The risk of an occurrence of a primary endpoint event was higher in the ARB group than the ACEI group [P = 0.037, hazard ratios (HR): 2.124, 95% confidence interval (95% CI): 1.048-4.306]. The Kaplan-Meier method also suggests that the rate of primary endpoint occurrence was higher in the ARB group than the ACEI group (P = 0.04). In regard to the secondary endpoints, there were no significant differences between the two treatment arms (P = 0.137, HR: 1.454, 95% CI: 0.888-2.380). Patient age and coronary heart disease history were independent predictors of the secondary endpoint.
CONCLUSION: ACEI were more effective than ARB in reducing cardiovascular and cerebrovascular morbidity and mortality in aged patients with hypertension.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470024/pdf/jgc-09-03-252.pdf
Tratamiento de la hipertensión arterial sistémica
Treatment of systemic hypertension.
Aronow WS.
Cardiology Division, Department of Medicine, New York Medical College Valhalla, New York, USA.
Am J Cardiovasc Dis. 2012;2(3):160-70. Epub 2012 Jul 25.
Abstract
Systemic hypertension is a major risk factor for cardiovascular disease and is present in 69% of patients with a first myocardial infarction, in 77% of patients with a first stroke, in 74% of patients with chronic heart failure, and in 60% of patients with peripheral arterial disease. Double-blind, randomized, placebo-controlled trials have found that antihypertensive drug therapy reduces cardiovascular events in patients aged younger than 80 years and in patients aged 80 years and older in the Hypertension in the Very Elderly Trial. Although the optimal blood pressure treatment goal has not been determined, existing epidemiologic and clinical trial data suggest that a reasonable therapeutic blood pressure goal should be <140/90 mm Hg in patients younger than 80 years and a systolic blood pressure of 140-145 mm Hg if tolerated in patients aged 80 years and older. Non-pharmacologic lifestyle measures should be encouraged both to prevent development of hypertension and as adjunctive therapy in patients with hypertension. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium channel blockers, and diuretics have all reduced cardiovascular events in randomized trials. The choice of specific drugs depends on efficacy, tolerability, presence of specific comorbidities, and cost
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427981/pdf/ajcd0002-0160.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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