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LA MOXONIDINA PODRIA REDUCIR EL RIESGO CARDIOVASCULAR A LARGO PLAZO DE LOS PACIENTES HIPERTENSOS CON SINDROME METABOLICO

(especial para SIIC © Derechos reservados)
La moxonidina es una opción terapéutica útil para muchos pacientes hipertensos con síndrome metabólico en riesgo de padecerlo debido a su mínimo potencial para promover o exacerbar este síndrome y la diabetes de reciente comienzo y así reducir el riesgo cardiovascular a largo plazo.
rayner9.jpg Autor:
Brian lindsay Rayner
Columnista Experto de SIIC

Institución:
University of Cape Town

Artículos publicados por Brian lindsay Rayner
Recepción del artículo
12 de Julio, 2006 		Aprobación
3 de Agosto, 2006
Primera edición
19 de Abril, 2007 		Segunda edición, ampliada y corregida
7 de Junio, 2021

LA MOXONIDINA PODRIA REDUCIR EL RIESGO CARDIOVASCULAR A LARGO PLAZO DE LOS PACIENTES HIPERTENSOS CON SINDROME METABOLICO

Resumen
Se analizaron las controversias recientes acerca de la validez y relevancia del síndrome metabólico como indicador de riesgo cardiovascular, con especial referencia a la interacción entre hipertensión, diabetes de reciente comienzo (DRC) y obesidad y el posible papel de la activación del sistema nervioso simpático como un factor subyacente. El riesgo cardiovascular a largo plazo en las personas obesas con hipertensión más diabetes es más alto que en aquellas que tienen sólo una de estas enfermedades. La selección de la terapia antihipertensiva debe tener en cuenta el diferente potencial de las drogas antihipertensivas para alterar la regulación de la insulina y la glucosa y provocar DRC y, por ende, deben priorizarse aquellas drogas con menos probabilidad de precipitar DRC. Estas consideraciones tienen importancia creciente en la práctica clínica en muchas partes de Sudamérica, donde la edad de la población y la urbanización conllevan un incremento en la prevalencia de obesidad, hipertensión arterial y diabetes. Las pruebas actuales sugieren que los agentes cuyo blanco es el sistema renina-angiotensina pueden reducir el riesgo de DRC; mientras que los diuréticos y especialmente los betabloqueantes pueden aumentar este riesgo. La moxonidina, un agonista de acción central del receptor de imidazolina, es otro antihipertensivo que parece tener efectos potencialmente ventajosos sobre la sensibilidad a la insulina. La experiencia clínica reciente con moxonidina comprende una serie de ensayos clínicos en pacientes obesos con hipertensión y desregulación de la insulina y la glucosa, principalmente los estudios ALMAZ y MARRIAGE; así como observaciones en personas con enfermedad renal. Los resultados de estos ensayos se consideraron en esta reseña y se utilizaron para elaborar una norma acerca de la elección de la terapia antihipertensiva en pacientes con elementos del síndrome metabólico.

Palabras clave
moxonidina, hipertensión, diabetes de reciente comienzo, síndrome metabólico, insuficiencia renal crónica


Artículo completo
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Moxonidine, Metabolic Syndrome and the MARRIAGE Study: A Review and Progress Report

Abstract
Recent controversies about the validity and relevance of metabolic syndrome as an indicator of cardiovascular risk are examined, with particular reference to the interplay of hypertension, new-onset diabetes mellitus (NOD) and obesity, and the possible role of sympathetic nervous system activation as an underlying factor. Long-term cardiovascular risk in obese individuals with hypertension plus diabetes is higher than in those who have only one of these conditions. Selection of hypertension therapy should therefore take account of the differing potential of antihypertensive drugs to impair insulin and glucose regulation, and induce NOD, and favour those drugs least likely to precipitate NOD. These considerations are a matter of growing practical importance in many parts of South America, where population ageing and urbanization are fuelling an increase in the prevalence of obesity, high blood pressure and diabetes. Current evidence suggests that agents that target the renin-angiotensin system may reduce the risk of NOD, whereas diuretics and especially beta-blockers may amplify this risk. The centrally acting imidazoline receptor agonist moxonidine is another antihypertensive that appears to have potentially advantageous effects on insulin sensitivity. Recent clinical experience with moxonidine includes a series of clinical trials in obese patients with hypertension and dysregulation of insulin and glucose, notably the ALMAZ and MARRIAGE trials, as well as observations in patients with renal disease. The results and findings of these studies are considered in this review and used to shape guidance on the choice of antihypertensive therapy for patients with elements of the metabolic syndrome.

Key words
moxonidine, hypertension, diabetes, new-onset, metabolic syndrome, chronic renal failure


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Especialidades
Principal: Endocrinología y Metabolismo
Relacionadas: Bioquímica, Cardiología, Diabetología, Farmacología, Medicina Farmacéutica, Medicina Interna, Nutrición



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Brian L. Rayner, University of Cape Town, E 13 Groote Schuur Hospital, Observatory 7925, Ciudad del Cabo, Sudáfrica
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