RESUMEN
Although the risk of thromboembolism in chronic heart failure is high even in the absence of atrial fibrillation, the risk to benefit ratio of anticoagulation vs. antiplatelet therapy or no antithrombotic therapy is poorly defined in this population. Post hoc analysis of large therapeutic heart failure trials has estimated the risk of thromboembolism to be between 1 and 4.5%. However, most of these studies have included some patients with atrial fibrillation, and thromboembolism was not a predefined endpoint. At present, the evidence for either anticoagulation or antiplatelet therapy is limited and the results from current large-scale randomized studies are awaited. From the randomized studies carried out thus far, there is a beneficial trend in favour of anticoagulation therapy, with less hospitalization for heart failure compared with patients taking aspirin.
Asunto(s)
Anticoagulantes/uso terapéutico , Fibrinolíticos/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Nodo Sinoatrial/efectos de los fármacos , Anticoagulantes/farmacología , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Enfermedad Crónica , Fibrinolíticos/farmacología , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/fisiopatología , Humanos , Inhibidores de Agregación Plaquetaria/farmacología , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Nodo Sinoatrial/fisiopatología , Tromboembolia/etiología , Tromboembolia/prevención & controlRESUMEN
Hypertension is a leading cause of major adverse cardiovascular outcomes, including heart attacks and stroke. The most visible manifestation of target organ damage related to hypertension is left ventricular hypertrophy (LVH). LVH eventually predisposes to systolic and diastolic heart failure, and is associated with an even greater risk of stroke. Electrocardiography and echocardiography are usually used to quantify LVH, but cardiac MRI may be a more reproducible and accurate modality. Regression in LVH is associated with improved cardiovascular outcomes. Treatments aimed at LVH regression include restriction of salt, regular exercise and weight reduction. Blockade of the renin-angiotensin-aldosterone system is particularly effective in preventing cardiovascular and cerebrovascular events, and is often associated with the regression of LVH, a decrease in left atrial size and a reduced incidence of new-onset atrial fibrillation, which could all contribute towards a decrease in vascular events. Overall, a reduction in blood pressure is still the most important factor in prevention of disease progression, and early treatment averts the risk of subsequent heart failure and stroke.