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Clínica e Investigación en Arteriosclerosis
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Inicio Clínica e Investigación en Arteriosclerosis Tratamiento preventivo del ictus
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Vol. 18. Núm. S1.
Hot topics en arteriosclerosis
Páginas 20-33 (junio 2006)
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Vol. 18. Núm. S1.
Hot topics en arteriosclerosis
Páginas 20-33 (junio 2006)
Hot topics en arteriosclerosis
Acceso a texto completo
Tratamiento preventivo del ictus
Stroke Prevention
Visitas
393
A. Roca-Cusachs
Autor para correspondencia
aroca@santpau.es

Correspondencia: Dr. A. Roca-Cusachs. Unidad de Hipertensión. Servicio de Medicina Interna. Hospital de la Santa Creu i Sant Pau. Sant Antoni M. Claret, 167. 08025 Barcelona. España.
Unidad de Hipertensión. Servicio de Medicina Interna. Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona. Barcelona. España
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Bibliografía
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El fundamento de la prevención del ictus se basa inequívocamente en el tratamiento de la hipertensión arterial (HTA). Con él se reduce intensamente el riesgo de presentar tanto un primer accidente vascular cerebral como la recidiva de ictus. Esta disminución del riesgo es en gran parte dependiente de la mera reducción de cifras de presión arterial (PA), aunque es probable que existan diferencias entre fármacos. Pero también otros factores influyen sobre dicho riesgo. Éste es el caso del colesterol: su tratamiento con estatinas ha demostrado ser beneficioso tanto en prevención secundaria como primaria de pacientes de alto riesgo. Una misma opinión merecen los antiagregantes, que desempeñarían un papel preventivo similar, mientras que los anticoagulantes sólo estarían indicados en la prevención del ictus de origen embólico. Por último, a todo ello cabe añadir el probable beneficio (científicamente no comprobado) de intervenciones basadas en cambios en el estilo de vida.

Palabras clave:
Hipertensión arterial
Ictus
Accidente vascular cerebral
Tratamiento antihipertensivo
Estatinas
Antiagregantes
Descoagulación
Estilo de vida
Prevención

Stroke prevention is unequivocally based on the treatment of hypertension, which drastically reduces the risk of both a first stroke and recurrence. This reduced risk is largely dependent on simply reducing blood pressure values, although there may be differences among drugs. However other factors also influence the risk of stroke. This is the case of cholesterol: its treatment with statins has been shown to be beneficial both in primary and secondary prevention in patients at high risk. The same is true of antiaggregants, which could play a similar preventive role, while anticoagulants are only indicated in the prevention of embolic stroke. Lastly, the probable benefit (not scientifically proven) of interventions based on lifestyle changes should be mentioned.

Key words:
Hypertension
Stroke
Cerebrovascular accident
Antihypertensive treatment
Statins
Antiaggregants
Decoagulation
Lifestyle
Prevention
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Bibliografía
[1.]
Insituto Nacional de Esadísitca. Defunciones según la causa de muerte 2002. Disponible en: http://www.ines.es
[2.]
S.E. Straus, S.R. Majumdar, F.A. McAlister.
New evidence for stroke prevention.
JAMA, 288 (2002), pp. 1388-1395
[3.]
M. Harrington, Kincaid, P. Smith, J. McMichael.
Results of treatment of malignant hypertension.
Br Med J, 2 (1955), pp. 969-989
[4.]
M. Hamilton, E.N. Thompson, T.K.M. Wisniewski.
The role of blood pressure control in preventing complications of hypertension.
Lancet, 1 (1964), pp. 235-238
[5.]
Veterans Administration Cooperative Study Group on Antihypertensive Agents.
Effects of treatment on mobidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg.
JAMA, 202 (1967), pp. 1028-1034
[6.]
Veterans Administration Cooperative Study Group on Antihypertensive Agents.
Effects of treatment on mobidity in hypertension. Results in patients with diastolic blood pressures averaging 90 through 114 mm Hg.
JAMA, 213 (1970), pp. 1143-1152
[7.]
R. Collins, R. Peto, S. MacMahon, P. Herbert, N.H. Fiebach, K.A. Eberlein, et al.
Blood pressure, stroke, and coronary heart disease-part 2. Short-term reduction in blood pressure: overview of randomised drug trials in their epidemiological context.
Lancet, 335 (1990), pp. 827-839
[8.]
R. Collins, S. MacMahon.
Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease.
Brit Med Bull, 50 (1994), pp. 272-298
[9.]
J.A. Staessen, J. Gasowski, J.G. Wang, L. Thijs, E. Den Hond, J.P. Biossel, et al.
Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials.
Lancet, 355 (2000), pp. 865-872
[10.]
S. MacMahon, A. Rodgers.
The effects of antihypertensive treatment on vascular disease: reappraisal of the evidence in 1993.
J Vasc Med Biol, 4 (1994), pp. 265-271
[11.]
Heart Outcomes Prevention Evaluation (HOPE) Study Investigators.
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy.
Lancet, 355 (2000), pp. 253-259
[12.]
Blood Pressure Lowering treatment Triallist's Collaboration.
Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials.
Lancet, 362 (2003), pp. 1527-1535
[13.]
M.H. Messerli.
Implications of discontinuation of doxazosin arm of ALLHAT.
Lancet, 355 (2000), pp. 863-864
[14.]
Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet. 1999;353:611-6.
[15.]
J.A. Staessen, J.G. Wang, L. Thijs, et al.
Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1st March 2003.
J Hypertens, 21 (2003), pp. 1055-1076
[16.]
The antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT).
Major outcomes in high-risk hypertensive patients randomized to antiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic.
JAMA, 288 (2002), pp. 2981-2997
[17.]
E.J. Lewis, L.G. Hunsicker, W.R. Clarke, T. Berl, M.A. Pohl, J.B. Lewis, et al.
Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.
N Engl J Med, 345 (2001), pp. 851-860
[18.]
B.M. Brenner, M.E. Cooper, D. De Zeeuw, W.F. Keane, W.E. Mitch, H.H. Parving, et al.
Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.
N Engl J Med, 345 (2001), pp. 861-869
[19.]
H. Lithell, L. Hansson, I. Skoog, D. Elmfeldt, A. Hofman, B. Olofson, For the SCOPE Study Group, et al.
The Study of Cognition and prognosis in the Elderly (SCOPE): principal results of randomized double-blind intervention trial.
[20.]
B. Dahlöf, R.B. Devereux, S.E. Kjeldsen, S. Julius, G. Beevers, U. De Faire, et al.
Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol.
Lancet, 359 (2002), pp. 995-1003
[21.]
M.A. Pfeffer, K. Swedberg, B. Granger, P. Held, J.JV. McMurray, E.L. Michelson, For the CHARM investigators and committees, et al.
Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme.
Lancet, 362 (2003), pp. 759-766
[22.]
S. Julius, S.E. Kjeldsen, M.A. Weber, H.R. Brunner, et al.
Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial.
Lancet, 363 (2004), pp. 2049-2122
[23.]
Morbidity and mortality after stroke.
Eprosartan Compared with nitrendipine for secondary prevention: principal results of a prospective randomized controlled study (MOSES).
[24.]
N.R. Poulter, H. Wedel, B. Dalilof, P.S. Sever, D.G. Beevers, M. Coulfield, ASCOT investigators, et al.
Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA).
[25.]
L.H. Lindholm, B. Carlberg, O. Samuelsson.
Should beta blockers remain first choice in the treatment of primary hypertension?.
Lancet, 366 (2005), pp. 1545-1553
[26.]
A.B. Carter.
Hypotensive therapy in stroke survivors.
Lancet, I (1970), pp. 1485-1489
[27.]
Hypertension-Stroke Cooperative Study Group.
Effect of antihypertensive treatment on stroke recurrence.
JAMA, 229 (1974), pp. 409-418
[28.]
The Dutch TIA Trial Study Group.
Trial of secondary prevention with atenolol after transient ichemic attack or nondisabling ischemic stroke.
Stroke, 24 (1993), pp. 543-548
[29.]
S. Eriksson, B.O. Olofsson, P.O. Wester.
Atenolol in secondary prevention after stroke.
Cerebrovasc Dis, 5 (1995), pp. 21-25
[30.]
PATS Collaborating Group.
Post-stroke antihypertensive treatment study. A preliminary result.
Chin Med (Eng), 108 (1995), pp. 710-717
[31.]
J. Bosch, S. Yusuf, J. Pogue, J. Probstfield, R. Díaz, R. Hoeschen, et al.
Impact of ramipril and vitamin E on cerebrovascular events in the HOPE (The Heart Outcomes Prevention Evaluation) trial [abstract].
J Am Coll Cardiol, 35 (2000), pp. 324.
[32.]
PROGRESS Collaborative Group.
Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or tansient ischqemic attack.
Lancet, 358 (2001), pp. 1033-1041
[33.]
P. Rashid, J. Leonardi-Bee, P. Bath.
Blood pressure reduction and secondary prevention of stroke and other vascular events. A systematic review.
[34.]
B. Zieden, A.G. Olsson.
The role of statins in the prevention of ischemic stroke.
Curr Atheroscler Rep, 5 (2005), pp. 364-368
[35.]
Cholesterol Treatment Trialists (CTT) Collaborators.
Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
Lancet, 366 (2005), pp. 1267-1278
[36.]
M.R. Law, N.J. Wald, A.R. Rudnicka.
Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disese, and stroke: systematic review and meta-analysis.
BMJ, 326 (2003), pp. 1423-1429
[37.]
P.S. Sever, B. Dahlöf, N.R. Poulter, H. Wedel, G. Beevers, M. Caulfield, et al.
Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.
Lancet, 361 (2003), pp. 1149-1158
[38.]
Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy: I.
Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients.
BMJ, 308 (1994), pp. 81-106
[39.]
Antithrombotic Trialists’ Collaboration.
Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.
BMJ, 324 (2002), pp. 71-86
[40.]
G. Hankey, C. Sudlow, D.W. Dunbabin.
Thienopyridines versus aspirin to prevent stroke and other serious vascular events in patients at high risk of vascular disease? A systematic review of the evidence from randomized trials.
Stroke, 31 (2000), pp. 1779-1784
[41.]
J.Y. Chong, J.P. Mohr.
Anticoagulant and platelet antiagregation therapy in stroke prevention.
Curr Opin Neurol, 18 (2005), pp. 53-57
Copyright © 2006. Sociedad Española de Arteriosclerosis y Elsevier España S.L.
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