ISSN: 0300-8932 Factor de impacto 2023 7,2
Vol. 11. Núm. D.
Páginas 25-36 (Junio 2011)

Inhibición directa de la renina y enfermedad cardiovascular. Más allá de la hipertensión

Direct Renin Inhibition and Cardiovascular Disease. Beyond Hypertension

Vicente Giner Galvaña¿Josep Redón i MasbAntonio Cocac

Opciones

Resumen

La evidencia acumulada en los últimos años muestra que en el manejo del paciente hipertenso no es suficiente con reducir las cifras de presión arterial, especialmente en los hipertensos de alto riesgo cardiovascular, pues en ellos persiste un riesgo residual muy considerable a pesar de la correcta implementación del tratamiento farmacológico y de conseguir los objetivos de presión que recomiendan las guías clínicas internacionales. Por eso, en los últimos años se ha intentado probar los efectos beneficiosos de las distintas estrategias antihipertensivas más allá de la mera reducción de presión. Conseguir un bloqueo intenso del sistema renina-angiotensina-aldosterona (SRAA) aparece en el centro de tales estrategias en los pacientes con riesgo cardiometabólico. La existencia demostrada de fenómenos de escape de la aldosterona observados a pesar de la inhibición de los distintos pasos de la cascada enzimática del SRAA es la base para buscar estrategias de bloqueo más intenso del SRAA interfiriendo simultáneamente la enzima de conversión de la angiotensina con sus inhibidores (IECA) y el receptor AT1 de la angiotensina II con los antagonistas de este (ARA). Sin embargo, el impacto negativo del bloqueo dual que en general tienen en los electrolitos y la función renal ha frenado su generalización. Por la importancia fisiopatológica de la renina como paso regulador inicial del SRAA y la reciente posibilidad de su inhibición con aliskiren, el primer inhibidor directo de la renina, se han abierto nuevas expectativas de un efecto diferenciador, al menos en algunos pacientes como los diabéticos, en sus efectos beneficiosos comparados con el bloqueo tradicional con IECA, ARA o su combinación. Este artículo revisa los datos disponibles hasta el momento sobre los posibles efectos pleotrópicos de los IDR que acompañan a la reducción de la presión arterial en pacientes hipertensos con distintas formas de enfermedad cardiovascular, particularmente aquellas con mayor actividad del sistema renina-angiotensina intracelular, como es el caso de la diabetes tipo 2.

Palabras clave

Inhibidor directo de la renina
Aliskiren
Lesión de órgano diana
Riesgo cardiometabólico
Diabetes mellitus
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