CURVA J HIPERTENSION Argumentos en Contra ?

Dr. Daniel Meneses Jefe Hemodinámica

Hospital Metropolitano “Vivian Pellas”

Managua. Nicaragua

APERTURA

ESTA

BIL

IDA

D

0 mmHg Blood Pressure 200 mmHg

CV

Disease

1 000 000 POR 14 AÑOS

All-cause mortality, CVD, and cancer mortality were highest in the low-DBP group (<75 mm Hg). Thus, comorbidities such as cancer and thus low weight and hypotension were the confounding factors that obscured the true relationship of BP and mortality.

HOT

Slim Jim /NK/1 14/05/20041

Hypertension

Optimal

TreatmentInternational Study

Hypertension

Optimal

TreatmentInternational Study

HOTHOT Study resultsStudy results

0

80

85

90

95

100

105

0 3 6 12 24 36 Final follow-up

74%

43%

DBP mm Hg

target 80 mm Hg

86%

73%

55%

target 85 mm Hg

target 90 mm Hg

HOT - Target blood pressure is an achievable goal

(% patients reaching target)

60%

Hansson et al 1998

Months

Risk of a major cardiovascular event reduced by 30% in the HOT Study

0

5

10

15

20

25

30

105 100 95 90 85

% risk reduction

Optimal DBP reduction in the HOT Study

Hansson et al 1998

Achieved DBP mm Hg 80

Vaccarino V, Holford TR, Krumholz HM. Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol 2000;36:130–8.

1. LA CURVA J ESTA PRESENTE EN MUCHOS ESTUDIOS DE HIPERTENSION ARTERIAL RELACIONANDO MORTALIDAD CARDOVASCULAR CON PRESION DIASTOLICA

2. LA CURVA J ES MAS COMUN EN PACIENTES CON ENFERMEDAD

ATEROSCLEROTICA AVANZADA 3. LA CAUSA DE ESTA CURVA ES AUN CONTROVERSIAL PORQUE LOS ESTUDIOS

NO HAN SIDO DISEÑADOS EXPRESAMENTE PARA ESTUDIAR ESTA RELACION 4. DEBE BUSCARSE REDUCIR LA PRESION SISTOLICA DEBAJO DE 140 mmHg Y LA DIASTOLICA DEBAJO DE 90 mmHg EN LOS PACIENTES DE ALTO RIESGO SIN IR “ MAS BAJO MEJOR”