Papel del tratamiento antihipertensivo en la prevención de la insuficiencia cardiaca

Important aspects of the treatment of CHF due to hypertension are identifying predisposing factors and preventing their appearance. Sinus rhythm should be maintained, though if atrial fibrillation is present, strict heart rate control is essential for preventing the development of CHF. To date, no study has investigated the best pharmacological treatment for diastolic heart failure. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (ARA IIs) may be useful because they have antihypertensive effects and reverse left ventricular hypertrophy. If there is fluid retention, a diuretic should be administered. Betablockers and calcium channel blockers that induce bradycardia, a beneficial effect in these patients, may be useful. The treatment of patients with hypertension and left ventricular dysfunction is no different from that recommended for those with chronic heart failure by clinical guidelines from the European Society of Cardiology and the American College of Cardiology/ American Heart Association. Treatment includes the use of ACE inhibitors and beta-blockers since both have been shown to reduce mortality in CHF. When ACE inhibitors are contraindicated, ARA IIs should be prescribed, and when there is fluid retention, diuretics should be administered. If symptoms persist, digoxin may be beneficial. The addition of spironolactone to ACE inhibitors and beta-blockers has been shown to improve survival in these patients.