[Patent foramen ovale. An update for primary care]. / Foramen oval permeable. Una actualización para atención primaria.

Patent foramen ovale (FOP) is the most prevalent cause of cryptogenic strokes in people under 60 years old. Although it is usually asymptomatic, it has a high risk of producing paradoxical embolism and, therefore, stroke with indeterminate outcomes. The study should be started based on clinical suspicion, and includes a multidisciplinary assessment and a determination of the type of treatment to be performed. The therapeutic possibilities range from conservative treatment (indefinite antithrombotic treatment), to its percutaneous closure (currently the most widely used). The first objective is to decrease the number of stroke recurrences. Conservative treatment should be reserved for those cases of low embolic risk. The risk assessment must be individualised, fundamentally based on the anatomical characteristics of the FOP and the patient clinic picture. The use of the RoPE risk scale (The Risk of Paradoxical Embolism) should be a tool to consider.

A propósito de tres casos: ptosis y cefalea en diferentes escenarios / Ptosis and headaches in different scenaries: a presentation of 3 cases

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¿Cómo y por qué calculamos el riesgo vascular en el paciente hipertenso? / How and why we calculate the vascular risk in hypertensive patients?

La valoración del riesgo vascular supone una visión holística y global del paciente. Conocer la probabilidad de la morbimortalidad a la que puede estar expuesto un individuo en función de sus características y de sus factores de riesgo debe ser una aproximación sistemática para decidir cuándo iniciar su tratamiento y si este debe incluir de forma inmediata fármacos para disminuir los factores de riesgo cardiovascular, junto con cambios en el estilo de vida. Son varias las guías de práctica clínica recientes que abogan por esta práctica, aunque no existen ensayos clínicos que hayan demostrado una ventaja sustancial sobre el abordaje de los factores de riesgo cardiovascular individuales. Es en hipertensión arterial, además de en dislipemias, donde existe más acuerdo sobre la eficacia de estas medidas y donde su utilización puede ser más rentable. Tanto las tablas cualitativas (guía europea de hipertensión arterial) como las cuantitativas (en nuestro medio SCORE) están disponibles y son complementarias para conocer qué pacientes son de alto riesgo y, por tanto, susceptibles de iniciar de forma inmediata un tratamiento farmacológico. Los médicos de familia deben introducir la valoración del riesgo vascular en su práctica clínica habitual, y catalogar al paciente y las actividades terapéuticas consecuentes en función de dicho cálculo de forma periódica

Cardiovascular risk assessment is of key importance for a global diagnosis of the hypertensive patient. Cardiovascular risk stratification according blood pressure levels, presence of accompanying cardiovascular risk factors, and presence of subclinical and/or clinical organ damage, constitute a systematic approach to assess risk for cardiovascular morbidity and mortality, to decide about initial antihypertensive treatment, and to promote global cardiovascular risk management. Several recent clinical practice guidelines recommend this approach, although there are no clinical trials demonstrating advantages of this management versus treating cardiovascular risk factors individually. Guidelines for management of high blood pressure and that for management of dyslipidemias constitute examples of agreement about the convenience of assessing global cardiovascular risk. Both qualitative (European guidelines for management of arterial hypertension) and quantitative (SCORE) tables are available, both useful for identification of high-risk patients, and indicating the necessity of starting simultaneous non-pharmacological and pharmacological treatment. Family doctors should include in their usual clinical practice a systematic approach to cardiovascular risk assessment, thus diagnosing the individual cardiovascular risk burden, and consequently applying therapeutic management to reduce future risk of cardiovascular morbidity and mortality

[How and why we calculate the vascular risk in hypertensive patients?] / ¿Cómo y por qué calculamos el riesgo vascular en el paciente hipertenso?

Cardiovascular risk assessment is of key importance for a global diagnosis of the hypertensive patient. Card iovascular risk stratification accord ing blood pressure levels, presence of accompanying cardiovascular risk factors, and presence of subclinical and/or clinical organ damage, constitute a systematic approach to assess risk for cardiovascular morbidity and mortality, to decide about initial antihypertensive treatment, and to promote global cardiovascular risk management. Several recent clinical practice guidelines recommend this approach, although there are no clinical trials demonstrating advantages of this management versus treating cardiovascular risk factors individually. Guidelines for management of high blood pressure and that for management of dyslipidemias constitute examples of agreement about the convenience of assessing global cardiovascular risk. Both qualitative (European guidelines for management of arterial hypertension) and quantitative (SCORE) tables are available, both useful for id entification of high-risk patients, and indicating the necessity of starting simultaneous non-pharmacological and pharmacological treatment. Family doctors should include in their usual clinical practice a systematic approach to cardiovascular risk assessment, thus diagnosing the individual cardiovascular risk burden, and consequently applying therapeutic management to reduce future risk of cardiovascular morbidity and mortality.