Armario Pedro, Brotons Carlos, Elosua Roberto, Alonso de Leciñana Maria, Castro Almudena, Clarà Albert, Cortés Olga, Díaz Rodriguez Ángel, Herranz María, Justo Soledad, Lahoz Carlos, Pedro-Botet Juan, Pérez Pérez Antonio, Santamaria Rafael, Tresserras Ricard, Aznar Lain Susana, Royo-Bordonada Miguel Ángel
Sociedad Española-Liga Española para la Lucha contra la Hipertensión Arterial, Madrid, España.
Sociedad Española de Medicina de Familia y Comunitaria, Barcelona, España.
Hipertens Riesgo Vasc. 2021 Jan-Mar;38(1):21-43. doi: 10.1016/j.hipert.2020.07.004. Epub 2020 Oct 14.
We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.
我们展示了更新后的欧洲心血管疾病预防指南在西班牙的适应性调整。在此次更新中,更加强调以人群为导向的方法,特别是通过西班牙的饮食、休闲和主动交通政策来促进体育活动和健康饮食。为了评估血管风险,应当注意重新校准所用表格的重要性,使其适应风险因素患病率和血管疾病发病率的人群变化,尤其要关注慢性肾脏病的作用。在个体层面,关键要素包括对行为改变的个性化支持、高危个体和血管疾病患者对药物治疗的依从性、促进体育活动以及戒烟。此外,还对近期使用前蛋白转化酶枯草溶菌素9(PCSK9)抑制剂的临床试验进行了综述,以及简化动脉高血压药物治疗以改善治疗控制和依从性的必要性。对于2型糖尿病合并血管疾病或高血管疾病风险的患者,当生活方式改变和二甲双胍治疗不足时,应优先使用已证实具有血管益处的药物。最后,纳入了关于外周动脉疾病和其他特定疾病的指南,以及一项关于在一级预防中不建议开具抗血小板药物的建议。