Prevención del desarrollo de lesión orgánica en los diferentes estadios del continuum cardiorrenal
Prevención de la progresión y regresión de la lesión orgánica. Estrategias de futuro
Prevention of progression and regression of target organ damage. Future strategies
A. de la Sierra
Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Mútua Terrassa, Universidad de Barcelona, Barcelona, España
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Ruiz Cantero" "autores" => array:1 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ruiz Cantero" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256511700029?idApp=WRCEE" "url" => "/00142565/00000211000000S1/v1_201302081047/S0014256511700029/v1_201302081047/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Prevención del desarrollo de lesión orgánica en los diferentes estadios del <span class="elsevierStyleItalic">continuum</span> cardiorrenal</span>" "titulo" => "Prevención de la progresión y regresión de la lesión orgánica. Estrategias de futuro" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "8" "paginaFinal" => "14" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "A. de la Sierra" "autores" => array:1 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "de la Sierra" "email" => array:1 [ 0 => "adelasierra@mutuaterrassa.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Hipertensión, Servicio de Medicina Interna, Hospital Mútua Terrassa, Universidad de Barcelona, Barcelona, España" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Prevention of progression and regression of target organ damage. Future strategies" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec18100" "palabras" => array:6 [ 0 => "Sistema renina-angiotensina" 1 => "Enfermedad cardiovascular" 2 => "Riesgo residual" 3 => "Prevención" 4 => "Lesión orgánica" 5 => "Continuo cardiorrenal" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec18099" "palabras" => array:6 [ 0 => "Renin-angiotensin system" 1 => "Cardiovascular disease" 2 => "Residual risk" 3 => "Prevention" 4 => "Organ lesion" 5 => "Cardiorenal disease continuum" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con bloqueadores del sistema renina-angiotensina (inhibidores de la enzima de conversión de la angiotensina y antagonistas del receptor AT1) ha demostrado beneficios evidentes en los diferentes estadios evolutivos de la enfermedad cardiovascular (ECV). Dicho tratamiento reduce la presión arterial y previene la aparición de marcadores subclínicos como la microalbuminuria, reduce los episodios cardiovasculares y renales en pacientes con lesión subclínica y alarga la supervivencia en pacientes con enfermedad clínica o disfunción orgánica. A pesar de este beneficio incuestionable, el riesgo residual de los pacientes que reciben dichos tratamientos sigue siendo, en muchos casos, muy elevado, por lo que es necesario planificar estrategias que permitan reducir dicho riesgo. En el presente artículo se revisan opciones que pueden ayudar a reducir la enfermedad cardiovascular más allá del tratamiento con bloqueadores del sistema renina-angiotensina y que van desde la prevención primordial en el individuo sano, objetivos terapéuticos más estrictos, control integral del riesgo, bloqueo más completo del sistema o el empleo de fármacos que presenten mecanismos de sinergismo en su capacidad protectora.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Treatment with renin-angiotensin system blockers (angiotensin converting-enzyme inhibitors and AT1 receptor antagonists) has shown clear benefits in distinct stages of cardiovascular disease (CVD). This treatment lowers blood pressure and prevents the appearance of markers of subclinical disease such as microalbuminuria, reduces cardiovascular and renal episodes in patients with subclinical lesions and prolongs survival in patients with clinical disease or organ dysfunction. Despite this unquestionable benefit, the residual risk in patients receiving these treatments often continues to be highly elevated and consequently strategies to reduce this risk are required. The present article reviews the options that may help to reduce cardiovascular disease. In addition to renin-angiotensin system blockers, these treatments include primary prevention in healthy individuals, stricter therapeutic goals, comprehensive risk control, more complete blocking of the renin-angiotensin system and the use of drugs with synergistic protective mechanisms.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:48 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.D. Flather" 1 => "S. Yusuf" 2 => "L. Kober" 3 => "M. Pfeffer" 4 => "A. Hall" 5 => "G. 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