ABSTRACT
Worsening heart failure (HF) is a vulnerable period in which the patient has a markedly high risk of death or HF hospitalization (up to 10% and 30%, respectively, within the first weeks after episode). The prognosis of HF patients can be improved through a comprehensive approach that considers the different neurohormonal systems, with the early introduction and optimization of the quadruple therapy with sacubitril-valsartan, beta-blockers, mineralocorticoid receptor antagonists, and inhibitors. Despite that, there is a residual risk that is not targeted with these therapies. Currently, it is recognized that the cyclic guanosine monophosphate deficiency has a negative direct impact on the pathogenesis of HF, and vericiguat, an oral stimulator of soluble guanylate cyclase, can restore this pathway. The effect of vericiguat has been explored in the VICTORIA study, the largest chronic HF clinical trial that has mainly focused on patients with recent worsening HF, evidencing a significant 10% risk reduction of the primary composite endpoint of cardiovascular death or HF hospitalization (number needed to treat 24), after adding vericiguat to standard therapy. This benefit was independent of background HF therapy. Therefore, optimization of treatment should be performed as earlier as possible, particularly within vulnerable periods, considering also the use of vericiguat.
Subject(s)
Heart Failure , Heterocyclic Compounds, 2-Ring , Pyrimidines , Ventricular Dysfunction, Left , Humans , Stroke Volume , Treatment Outcome , Heart Failure/drug therapy , Ventricular Dysfunction, Left/drug therapyABSTRACT
The aim of the study was to determine whether there are differences in subclinical vascular disease (SVD) in hypertensive patients in relation to height. A total of 922 hypertensive, newly diagnosed, treatment-naive patients were included. Physical examination was conducted, with renal function, electrocardiography, and retinography. Patients were distributed according to quartiles of height and sex. Multivariate analysis adjusted for age, sex, and body mass index showed an association between height above the mean and fasting glucose (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06), high-density lipoprotein cholesterol (OR, 0.96; CI, 0.92-0.99), triglycerides (OR, 1.07; CI, 1.01-1.15), and left ventricular hypertrophy (LVH) (OR, 1.57; CI, 1.10-2.24). The authors found an inverse association between arteriole-to-venule ratio and height above the mean (OR, 0.97; CI, 0.94-0.99). There are differences in the SVD of hypertensive patients in relation to height. Tall stature is associated with LVH while short stature is associated with increased microvascular involvement. Detection of SVD in hypertensive patients should consider the height.
Subject(s)
Body Height/physiology , Hypertension/complications , Hypertensive Retinopathy/epidemiology , Hypertrophy, Left Ventricular/epidemiology , Vascular Diseases/epidemiology , Aged , Body Mass Index , Female , Humans , Hypertension/physiopathology , Male , Middle Aged , Multivariate Analysis , Prevalence , Prospective Studies , Risk Factors , Sex FactorsABSTRACT
Para minimizar el riesgo cardiovascular derivado de la hipertensión arterial (HTA) es de vital importancia alcanzar los objetivos terapéuticos, idealmente en el menor tiempo posible. La capacidad hipotensora de los diferentes fármacos está bien determinada por los diferentes estudios que avalan su uso. Por ello, el clínico debería elegir el tratamiento con criterio basándose en el descenso de presión arterial que requiera el paciente y utilizar un fármaco o combinación cuya potencia antihipertensiva permita prever que se logre el objetivo terapéutico. Olmesartán es un antagonista de los receptores de la angiotensina II (ARA II) de notable potencia hipotensora, bien tolerado y cuya combinación con dihidropiridinas y/o hidroclorotiazidas se halla bien establecida. En este artículo se revisan las evidencias que justifican el uso de olmesartán o sus combinaciones en el contexto actual del manejo de la HTA. Se presta especial atención en determinar la potencia hipotensora demostrada del fármaco para precisar los casos en los que es esperable alcanzar los objetivos terapéuticos, su comparación con otros fármacos de uso común, las evidencias en el control de la presión arterial durante las 24 h y la eficacia de las combinaciones terapéuticas (AU)
Achieving therapeutic targets is essential to reduce the cardiovascular risk of hypertension, ideally in as short a time as possible. The hypotensive effectiveness of the distinct drugs has been well characterized by the various studies supporting their use. Therefore, clinicians should base their selection of the drug to be used on the target blood pressure decrease required in each patient and prescribe a drug or drug combination with sufficient antihypertensive potency to achieve the desired reduction. Olmesartan is an angiotensin II receptor antagonist with marked hypotensive potency that is well tolerated and whose use in combination with dihydropyridines and/or hydrochlorothiazide has been well established. The present article reviews the evidence supporting the use of olmesartan as monotherapy or in combination treatment in the current context of the management of hypertension. Special attention is paid to determining the demonstrated blood pressure-lowering potency of this drug in situations in which the therapeutic targets can realistically be achieved; we compare this agent with other commonly used drugs and discuss the evidence on 24-hour blood pressure control, as well as the effectiveness of therapeutic combinations (AU)
