Los estudios de prevención primaria de la enfermedad cardiovascular en pacientes hipertensos han demostrado que el descenso sostenido de las cifras de presión sistólica y diastólica reduce la incidencia de cardiopatía isquémica, insuficiencia cardiaca (ICC), accidente cerebrovascular e insuficiencia renal, así como la mortalidad asociada a tales complicaciones en todas las razas, a cualquier edad y en ambos sexos. En prevención primaria de la ICC los diuréticos, los bloqueadores betaadrenérgicos (BB), los fármacos que bloquean el SRA, y sus combinaciones, son superiores a las estrategias basadas en calcioantagonistas.
En el tratamiento de la ICC secundaria a hipertensión arterial (HTA) es importante valorar los factores precipitantes, ya que evitar su aparición constituye una parte importante del tratamiento. Debe intentarse mantener el ritmo sinusal, y en presencia de AC x FA, mantener frecuencias cardiacas controladas es básico para evitar la aparición de ICC. No existen estudios farmacológicos que hayan analizado cuál es el mejor tratamiento de la ICC diastólica. Los IECAs y ARA II pueden ser útiles tanto por su efecto antihipertensivo como inductores de regresión de HVI. Los diuréticos deben administrarse cuando hay retención de líquidos. Los BB y algunos antagonistas del calcio que inducen bradicardia, un efecto deseable en estos pacientes, pueden ser de utilidad. El tratamiento del paciente hipertenso con disfunción ventricular izquierda no difiere del tratamiento de la ICC crónica recomendado en las Guías de Práctica Clínica de la ESC y del ACC/AHA. El tratamiento incluye IECAs y BB pues ambos han demostrado reducir la mortalidad de la ICC. Cuando hay contraindicación para los IECAs, deben prescribirse ARA II y cuando hay retención de líquidos deben administrarse diuréticos. Si persisten los síntomas, la digoxina suele ser beneficiosa. La espironolactona añadida a IECAs y BB ha demostrado mejorar la supervivencia de estos pacientes.
Palabras clave
Hipertensión arterial
Insuficiencia cardiaca
Hipertrofia ventricular
IECAs
ARA II
Bloqueadores beta
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