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August 3, 2007

Ocho de cada diez pacientes hipertensos con disfunción cardiaca presentan un mal control de las cifras de tensión arterial y hasta el 85% sufre obesidad

Filed under: Medicina, Otras Notas de Prensa — Elisabet @ 10:46 am

Se publican en la revista científica Hipertensión los resultados del estudio Valycor, que proporcionan una visión real y de conjunto de la situación en nuestro país del manejo del paciente hipertenso con disfunción cardiaca   Ocho de cada diez pacientes hipertensos con disfunción cardiaca presentan un mal control de las cifras de tensión arterial y hasta el 85% sufre obesidad 

  • El dato positivo que se extrae de este estudio es el bajo porcentaje de fumadores entre estos pacientes de alto riesgo cardiovascular, lo que revela la alta concienciación de las negativas consecuencias del tabaco tanto por parte de los pacientes como de los médicos

  • Más del 80% de los pacientes con hipertensión y disfunción cardiaca presentan cifras tensionales elevadas, muy lejos del objetivo recomendado

  • Valycor pone de relieve diferencias relativas tanto al perfil clínico del paciente, como al uso de pruebas diagnósticas o el abordaje terapéutico en función del ámbito asistencial en que es atendido el paciente

  • Un total de 206 médicos, tanto de Atención Primaria como de Especializada (cardiólogos e internistas) han participado en este estudio epidemiológico y transversal que ha incluido a 3.984 pacientes, realizado gracias a la colaboración de Novartis Farmacéutica 

Madrid, 3 de agosto de 2007.  La insuficiencia cardiaca representa un serio y creciente problema sanitario en los países desarrollados. En España constituye la primera causa de ingreso hospitalario y es uno de los principales responsables del gasto sanitario. El incremento que experimenta esta patología se encuentra relacionado en gran parte con el progresivo envejecimiento de la población y el aumento de las enfermedades propias del anciano, entre las que destacan la hipertensión. De hecho, se estima que entre el 50 y el 70% de los pacientes con insuficiencia cardiaca también sufre hipertensión arterial (HTA).  Por ello, las directrices internacionales subrayan la necesidad de un tratamiento enérgico y eficaz de la hipertensión para evitar sus complicaciones cardiacas. Sin embargo, se ha constatado que el control actual de la hipertensión en la práctica habitual dista aún de ser el adecuado.  

Hasta ahora pocos estudios han evaluado las diferencias en el manejo de estos pacientes entre ambos ámbitos asistenciales, aunque los datos existentes apuntan a que cardiólogos y médicos de Atención Primaria difieren en el manejo y tratamiento de estos pacientes.  Con el objetivo de definir el perfil clínico del paciente hipertenso con disfunción cardiaca y analizar el grado de control tensional y de los diferentes factores de riesgo cardiovascular en función del ámbito asistencial, se ha llevado a cabo el registro Valycor, promovido por

la Sección de Hipertensión Arterial de

la Sociedad Española de Cardiología, gracias a la colaboración de Novartis Farmacéutica.
 Un total de 206 médicos, tanto de Atención Primaria como de Especializada (cardiólogos e internistas) han participado en este estudio epidemiológico y transversal que ha incluido a 3.984 pacientes.   Según explica el Dr. Pedro Morillas, del  Servicio de Cardiología del Hospital Universitario de San Juan de Alicante y autor del estudio, la principal conclusión de Valycor es “el pésimo control de las cifras de presión arterial en estos pacientes, que además son de alto riesgo cardiovascular”. Por otro lado, más del 85% de estos pacientes sufría obesidad (determinada por un IMC>25), lo que unido a una proporción alta de dislipemia (50%) y diabetes mellitas tipo 2 (29%) refleja el cambio en el estilo de vida que está sufriendo nuestra sociedad, más sedentaria y con hábitos alimenticios poco saludables. Sin lugar a duda, la obesidad representa una verdadera pandemia, estando íntimamente asociada a la insuficiencia cardiaca. “Por tanto, debemos de ser conscientes de la importancia de este problema ya que lleva asociada hipertensión, un mayor riesgo de diabetes y de hipercolesterolemia”, señala el Dr. Morillas. El resultado positivo del estudio es que se ha constatado que existe una alta concienciación tanto por parte del médico como del paciente sobre las consecuencias negativas del tabaco. Así, mientras que en términos generales se calcula que en España una de cada tres personas fuma (en torno a un 30%), entre los pacientes incluidos en el estudio (de alto riesgo) el porcentaje se sitúa a la mitad (únicamente el 15% es fumador). 

Diferencias en función del ámbito asistencial: Primaria o Especializada

Valycor pone de manifiesto el distinto perfil clínico de los pacientes en función del ámbito asistencial: mientras que los atendidos en atención Primaria tienen una edad media más alta y un mayor porcentaje de diabetes, los atendidos por especialistas (especialmente cardiólogos) tienen mayores antecedentes de cardiopatía isquémica, insuficiencia renal y una hipertensión más severa.  Asumiendo estas diferencias, “nos ha llamado la atención –explica el Dr. Morillas- que en los pacientes incluidos desde atención especializada el grado de control de los niveles plasmáticos de glucemia es peor que en atención primaria. Esto supone un toque de atención al especialista para que nos responsabilicemos del control de la glucemia de estos pacientes”. Desde el punto de vista del diagnóstico, “merece la pena destacar la baja accesibilidad de los médicos de Atención Primaria a técnicas diagnósticas como el ecocardiograma, una prueba muy valiosa para conocer el tamaño y el funcionamiento de las cámaras cardíacas y que va a tener implicaciones terapéuticas y pronósticas. Así, el estudio revela que sólo el 15% de los pacientes atendidos en Atención Primaria disponen de un estudio ecocardiográfico realizado en el último año, muy inferior al de los pacientes incluidos desde Especializada (56%). Para el Dr. Morillas “la solución a esta carencia pasa por establecer una relación más estrecha con la atención especializada, que se elaboren protocolos comunes y que el médico de Primaria pueda solicitar directamente el ecocardiograma. Otra de las opciones que se baraja es el uso de los ecocardiogramas portátiles, que pudieran estar disponibles en las consultas de Atención Primaria, siempre tras una formación adecuada”. También se encontraron diferencias significativas en cuanto al tratamiento entre ambos ámbitos asistenciales. Así el estudio ha permitido concluir que mientras en Atención Primaria hay un bajo empleo de betabloqueantes, un grupo farmacológico que ha demostrado una significativa mejoría de la evolución de los pacientes con disfunción cardiaca, en Atención Especializada es necesario seguir estimulando la aplicación de medidas no farmacológicas en estos pacientes (dieta, ejercicio regular y abandono del tabaquismo). En definitiva, Valycor revela que pese a los importantes avances en la prevención y tratamiento de las enfermedades cardiovasculares, los objetivos de manejo de los diferentes factores de riesgo cardiovascular en nuestro país se encuentran muy por debajo de lo aconsejado por las principales guías. En concreto más del 80% de los pacientes con hipertensión y disfunción cardiaca presentaban cifras tensionales muy lejos del objetivo recomendado por las principales directrices. Al mismo tiempo, este estudio observacional muestra que la aproximación terapéutica a este paciente de alto riesgo es diferente según el ámbito asistencial en el que es atendido.  

Compromiso de Novartis con la investigación en enfermedad cardiovascular

Novartis está especialmente interesado en mejorar la atención a pacientes con hipertensión y enfermedad cardiovascular por medio de una investigación de talla mundial. Entre los ensayos publicados con Diovan destacan los estudios VALUE en pacientes hipertensos con riesgo de complicaciones cardiovasculares, VALIANT en pacientes que han sufrido un infarto de miocardio y Val-HeFT en pacientes con insuficiencia cardiaca. Los estudios en curso incluyen el ensayo NAVIGATOR, el mayor ensayo de resultados realizado para la prevención de enfermedad cardiovascular y diabetes tipo 2 en pacientes con tolerancia alterada a la glucosa.

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