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EL SISTEMA RENINA-ANGIOTENSINA-ALDOSTERONA Y EL ESTADO PROTROMBOTICO
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EL ÁCIDO ÚRICO SÉRICO ELEVADO AUMENTA EL RIESGO DE HIPERTENSIÓN ARTERIAL
Hypertension 71(1):78-86
Difundido en siicsalud: 10 jul 2019

EL SISTEMA RENINA-ANGIOTENSINA-ALDOSTERONA Y EL ESTADO PROTROMBOTICO

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Las anomalías de la hemostasia desempeñarían un papel en las complicaciones trombóticas de la hipertensión. Estas alteraciones pueden inducirse por la activación del sistema renina-angiotensina-aldosterona (SRAA). El potencial efecto antitrombótico de los inhibidores del SRAA podría contribuir a la preservación de la función cardiovascular.
remkova9_11211.gif Autor:
Anna Remkova
Columnista Experta de SIIC

Institución:
Slovak Medical University in Bratislava


Artículos publicados por Anna Remkova
Recepción del artículo
26 de Agosto, 2010
Aprobación
1 de Septiembre, 2010
Primera edición
30 de Enero, 2012
Segunda edición, ampliada y corregida
27 de Junio, 2012

Resumen
La hipertensión arterial se asocia con un incremento en el riesgo de eventos trombóticos oclusivos, como consecuencia de un estado protrombótico presente en los pacientes hipertensos. Una serie de anomalías de la hemostasia parecen desempeñar un papel en las complicaciones trombóticas de la hipertensión. Sistemáticamente se ha informado acerca de disfunción endotelial, incremento de la activación plaquetaria, aumento de la actividad del sistema de la coagulación y reducción de la función del sistema fibrinolítico en los pacientes hipertensos. Estas alteraciones pueden inducirse por la activación del sistema renina-angiotensina-aldosterona (SRAA) y contribuir a un mayor riesgo y gravedad del daño de los órganos blanco. El tratamiento antihipertensivo con antagonistas del SRAA podría revertir estas alteraciones protrombóticas. Dado que los inhibidores de la enzima convertidora de angiotensina (IECA) y los antagonistas del receptor de angiotensina II (ARA-II) tienen dos mecanismos diferentes de interrupción del SRAA, cada terapia podría tener repercusiones distintas sobre el estado protrombótico de los pacientes hipertensos. En algunos estudios se demostró un efecto beneficioso sobre el estado protrombótico de los IECA en particular y también de algunos ARA-II de forma parcial. El potencial efecto antitrombótico de los inhibidores del SRAA podría contribuir a la preservación de la función cardiovascular. Los datos disponibles pueden ofrecer una explicación adicional de la eficacia de los inhibidores del SRAA en la prevención de los eventos cardiovasculares en pacientes con enfermedad vascular aterosclerótica.

Palabras clave
hipertensión, endotelio, hemostasia, renina, angiotensina


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Abstract
Arterial hypertension is associated with increased risk of occlusive thrombotic events, reflecting a prothrombotic state that is present in hypertensive patients. A number of haemostatic abnormalities appear to play a role in the thrombotic complications of hypertension. Endothelial dysfunction, increased platelet activation, increased activity of the coagulation system, and the decreased function of the fibrinolytic system has been consistently reported in hypertensive patients. These abnormalities can be induced by the activated renin-angiotensin-aldosterone system (RAAS), and may contribute to the increased risk and severity of target organ damage. Antihypertensive treatment by RAAS inhibiting agents could result in a reversal of prothrombotic abnormalities. Since angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have two distinct mechanisms of RAAS interruption, each therapy might have different impact on the prothrombotic state in hypertensive patients. Some studies demonstrate a beneficial effect, mainly of ACE inhibitors and also partly of some ARBs on the prothrombotic state. The potentially antithrombotic effect of the RAAS inhibiting agents may in turn support the preservation of cardiovascular function. Available data may offer an additional explanation for the efficacy of the RAAS inhibiting agents in the prevention of cardiovascular events in patients with atherosclerotic vascular disease.

Key words
hypertension, endothelium, haemostasis, renin, angiotensin


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Especialidades
Principal: Cardiología, Hematología
Relacionadas: Bioquímica, Cuidados Intensivos, Diagnóstico por Laboratorio, Educación Médica, Geriatría, Medicina Interna, Nefrología y Medio Interno



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Enviar correspondencia a:
Anna Remkova, Slovak Medical University Department of Internal Medicine, 833 03, Limbova 12, Bratislava, Eslovaquia
Patrocinio y reconocimiento:
El trabajo fue financiado por una beca del Ministerio de Educación de Eslovaquia (VEGA grant No 1/0084/10).
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