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El tratamiento de la hipertensión arterial sistémica en pacientes con enfermedad arterial coronaria
Resumen
Los ensayos controlados aleatorios y los estudios observacionales prospectivos ofrecen los datos más confiables sobre la asociación entre la presión arterial y la cardiopatía coronaria (CC). Toda la evidencia indica que hay una fuerte asociación entre la presión arterial y la CC, que es continua a niveles menores a 115 mm Hg de presión sistólica. En general, de los 60 a los 69 años de edad, la presión arterial sistólica más baja en 10 mm Hg se asocia con riesgo menor de tener un evento de enfermedad coronaria. El tamaño y la forma de esta asociación son constantes en todas las regiones, para hombres y mujeres, y para eventos mortales como el infarto de miocardio y el accidente vascular cerebral. Los ensayos han demostrado que los beneficios de la reducción de la presión arterial con diferentes clases de fármacos (diuréticos, betabloqueantes, inhibidores de la ECA, antagonistas del calcio) son bastante similares, con una quinta parte de reducción en enfermedad coronaria. Los puntos importantes de esta revisión son: a) que los beneficios relativos a la baja de la presión arterial para la prevención de enfermedad coronaria parecen ser constantes en una gama de diferentes poblaciones; b) que es probable que se obtenga un beneficio considerable con la presión arterial baja, por debajo de umbrales de hipertensión «tradicional» (140/90 mm Hg), especialmente en aquellos con alto riesgo absoluto, y c) que iniciar, reducir con precaución (sobre todo en el adulto mayor) y mantener la reducción de la tolerancia máxima de la presión arterial es un problema más importante que la elección del agente inicial.
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