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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El minoxidil es un vasodilatador arteriolar aprobado en la d&#233;cada de 1970 como tratamiento de la hipertensi&#243;n refractaria grave&#44; con una dosis est&#225;ndar que oscilan entre 10 y 40<span class="elsevierStyleHsp" style=""></span>mg diarios &#40;hasta 100<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>&#46; En los &#250;ltimos a&#241;os&#44; el minoxidil oral a dosis bajas &#40;MODB&#41; se ha utilizado cada vez con mayor frecuencia en el tratamiento de distintos tipos de alopecia&#44; teniendo el respaldo de numerosos estudios que describen su eficacia y su perfil de seguridad favorable<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Uno de los estudios m&#225;s amplios describi&#243; exhaustivamente la frecuencia y cronolog&#237;a de los efectos adversos &#40;EA&#41; del tratamiento con MODB en 1404 pacientes<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a>&#46; La hipertricosis es un EA bien conocido y el m&#225;s frecuente de MODB y se presentar&#225; en aproximadamente el 15&#37; de los pacientes<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Aunque son infrecuentes&#44; pueden producirse EA sist&#233;micos que&#44; en una minor&#237;a de pacientes&#44; conducen a la interrupci&#243;n del tratamiento con MODB&#46; La mayor&#237;a de los EA sist&#233;micos est&#225;n relacionados con el efecto cardiovascular y hemodin&#225;mico del minoxidil&#44; incluyendo la presencia de mareos &#40;v&#233;rtigo&#44; hipotensi&#243;n postural&#41;&#44; retenci&#243;n de l&#237;quidos &#40;edema de miembros inferiores o facial&#41;&#44; taquicardia &#40;palpitaciones&#41;&#44; alteraciones del electrocardiograma &#40;principalmente en la onda T&#41;&#44; cefalea&#44; insomnio&#44; pesadillas o aumento del apetito<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;4&#44;6&#44;7</span></a>&#46; Estos EA son generalmente bien tolerados y se resuelven tras la interrupci&#243;n o el ajuste de la dosis del MODB&#46; Se han notificado EA graves con dosis altas de minoxidil oral cuando se utiliza para la hipertensi&#243;n grave o debido a errores de composici&#243;n en el tratamiento de la ca&#237;da del cabello&#44; incluyendo s&#237;ncope hipotensor&#44; pericarditis&#44; derrame peric&#225;rdico o infarto de miocardio<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#44;8</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Los EA sist&#233;micos representan la principal preocupaci&#243;n del tratamiento con MODB en la poblaci&#243;n general con p&#233;rdida de cabello&#44; que en su mayor&#237;a son adultos sanos de mediana edad&#46; Teniendo en cuenta que el MODB se utiliza como un tratamiento que est&#225; fuera de ficha t&#233;cnica&#44; estos problemas de seguridad adquieren mayor importancia cuando se prescribe en situaciones especiales&#44; como pacientes con antecedentes personales de hipertensi&#243;n arterial &#40;HTA&#41; o arritmia&#46; A&#250;n se desconoce si el MODB podr&#237;a potenciar el efecto hipotensor de otros f&#225;rmacos antihipertensivos o aumentar el riesgo de EA sist&#233;micos en estos pacientes&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El objetivo de este estudio fue evaluar la seguridad del MODB en el tratamiento de la ca&#237;da del cabello en pacientes con HTA o arritmia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudio de tipo retrospectivo&#44; descriptivo y multic&#233;ntrico incluy&#243; pacientes adultos con antecedentes personales de HTA o arritmia que estaban en tratamiento con MODB para la p&#233;rdida de cabello de cualquier causa durante al menos un mes&#59; los pacientes se incluyeron a partir de cinco centros de Brasil y Espa&#241;a&#44; desde enero de 2018 hasta abril de 2022&#46; La duraci&#243;n m&#237;nima del tratamiento de un mes se estableci&#243; teniendo en cuenta la cronolog&#237;a de los EA de MODB previamente descrita<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a>&#46; Los datos epidemiol&#243;gicos&#44; m&#233;dicos y de seguridad se recogieron de los registros m&#233;dicos de los pacientes&#44; incluidos los tratamientos previos para la HTA&#44; los EA y la necesidad de retirar o ajustar la dosis de MODB o los tratamientos antihipertensivos&#46; En algunos pacientes&#44; la dosis de MODB se titul&#243; en funci&#243;n de la respuesta y la tolerabilidad&#44; y los par&#225;metros anteriores se analizaron para cada dosis&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se realiz&#243; con IBM SPSS Statistics &#40;Versi&#243;n 25&#46;0&#58; IBM Corp&#46;&#44; 2017&#41;&#46; Las variables continuas se expresaron como media &#40;rango&#41;&#46; Se utiliz&#243; la regresi&#243;n log&#237;stica para identificar las variables asociadas con un mayor riesgo de EA sist&#233;micos&#44; suspensi&#243;n o ajuste de los tratamientos con MODB o antihipertensivos&#44; que se consideraron estad&#237;sticamente significativas si el valor P era<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Hipertensi&#243;n</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se incluyeron 254 pacientes &#91;176 mujeres &#40;69&#44;3&#37;&#41; y 78 hombres &#40;30&#44;7&#37;&#41;&#93; con una edad media de 56&#44;9 a&#241;os &#40;rango 19-82&#41;&#46; De ellos&#44; se titul&#243; la dosis de MODB en varias dosis increment&#225;ndolas seg&#250;n la tolerancia en 82 pacientes &#40;32&#44;2&#37;&#41;&#44; lo que permiti&#243; analizar 382 dosis diferentes&#46; La dosis media de MODB fue de 1&#44;59<span class="elsevierStyleHsp" style=""></span>mg &#40;rango 0&#44;2-10&#41; y la duraci&#243;n media fue de 10&#44;9 meses &#40;1-51&#41;&#46; El MODB fue la &#250;nica terapia sist&#233;mica para la ca&#237;da del cabello en 124 pacientes &#40;48&#44;8&#37;&#41;&#46; En los pacientes restantes&#44; el f&#225;rmaco concomitante m&#225;s frecuente fue la dutasterida oral&#46; La indicaci&#243;n m&#225;s frecuente para el tratamiento con MODB fue la alopecia androgen&#233;tica &#40;68&#44;9&#37;&#41;&#44; seguida de la alopecia frontal fibrosante &#40;10&#44;2&#37;&#41;&#44; el efluvio tel&#243;geno &#40;4&#44;3&#37;&#41;&#44; el liquen plano pilar &#40;3&#44;5&#37;&#41;&#44; la alopecia fibrosante en patr&#243;n de distribuci&#243;n &#40;3&#44;1&#37;&#41;&#44; la alopecia areata &#40;2&#44;4&#37;&#41; y otros tipos de alopecia menos frecuentes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Antes del tratamiento con MODB&#44; los pacientes recib&#237;an una media de 1&#44;4 f&#225;rmacos antihipertensivos &#40;rango 0-5&#41;&#46; S&#243;lo 5 pacientes &#40;1&#44;3&#37;&#41; no recib&#237;an tratamiento para la HTA&#46; La clase de f&#225;rmacos m&#225;s frecuente fueron los antagonistas de los receptores de la angiotensina II &#40;ARA-II&#41; en 190 pacientes &#40;49&#44;7&#37;&#41;&#44; seguidos de las tiazidas &#40;28&#44;5&#37;&#41;&#44; los betabloqueantes &#40;28&#37;&#41; y otros &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Se detectaron EA en 71 pacientes &#40;27&#44;9&#37;&#41; con 84 dosis &#40;21&#44;9&#37;&#41;&#46; El EA m&#225;s frecuente fue la hipertricosis en 49 pacientes &#40;19&#44;2&#37;&#41; con 61 dosis &#40;15&#44;9&#37;&#41;&#44; dado que 7 pacientes &#40;2&#44;7&#37;&#41; desarrollaron hipertricosis con varias dosis&#46; Se identificaron EA sist&#233;micos en 23 pacientes &#40;9&#37;&#41; con 26 dosis &#40;6&#44;8&#37;&#41; y entre estos se incluyeron los mareos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#59; 3&#46; 1&#37;&#41;&#44; la retenci&#243;n de l&#237;quidos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#59; 2&#44;6&#37;&#41;&#44; el malestar general &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; 0&#44;8&#37;&#41;&#44; taquicardia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; 0&#44;8&#37;&#41; y cefalea &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 0&#44;5&#37;&#41;&#46; Cinco pacientes &#40;1&#44;9&#37;&#41; desarrollaron m&#225;s de un EA&#58; hipertricosis m&#225;s mareo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; hipertricosis m&#225;s taquicardia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; mareo m&#225;s malestar general &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; y mareo m&#225;s malestar general m&#225;s retenci&#243;n de l&#237;quidos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44; que requiri&#243; la interrupci&#243;n del MODB&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todos los EA mejoraron con el ajuste de la dosis o la interrupci&#243;n del f&#225;rmaco&#44; y no se observaron EA potencialmente mortales&#46; La dosis de MODB se redujo en 14 casos &#40;3&#44;6&#37;&#41;&#44; de los cuales 8 se debieron a EA sist&#233;micos y 6 a hipertricosis&#46; Fue necesario interrumpir el tratamiento con MODB en 6 casos &#40;1&#46; 5&#37;&#41; debido a una intensa ca&#237;da del cabello &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; retenci&#243;n de l&#237;quidos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; mareos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; mareos m&#225;s malestar general &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; mareo&#44; malestar general m&#225;s retenci&#243;n de l&#237;quidos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; y taquicardia m&#225;s hipertricosis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#59; este paciente interrumpi&#243; el MODB por taquicardia&#44; luego reinici&#243; el tratamiento sin EA sist&#233;micos&#44; y volvi&#243; a interrumpirlo al cabo de 1 a&#241;o por hipertricosis&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El EA m&#225;s frecuente que condujo al ajuste o la retirada de la MODB fue el mareo &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#59; P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La hipertricosis se asoci&#243; con un mayor riesgo de ajuste de la dosis &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#44; pero no con la interrupci&#243;n &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;65&#41;&#46; La edad&#44; el sexo y la dosis de MODB no se asociaron con el riesgo de EA sist&#233;micos ni con el ajuste de MODB&#46; Otros factores asociados con el ajuste y la retirada de MODB se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Los pacientes que recib&#237;an 3 o m&#225;s f&#225;rmacos antihipertensivos ten&#237;an mayor riesgo de desarrollar m&#225;s de 1 EA &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; mareo &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; malestar general &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y de requerir la interrupci&#243;n del MODB &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;012&#41;&#46; Asimismo&#44; el tratamiento previo con doxazosina se asoci&#243; a un mayor riesgo de mareo &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; malestar general &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; retenci&#243;n de l&#237;quidos &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; y necesidad tanto de ajustar la dosis &#40;P<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41; como de retirar el MODB &#40;P<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento antihipertensivo&#44; s&#243;lo dos pacientes &#40;0&#44;7&#37;&#41; requirieron un ajuste o la interrupci&#243;n de su tratamiento previo&#46; Una mujer de 67 a&#241;os tratada con minoxidil 0&#44;5<span class="elsevierStyleHsp" style=""></span>mg y espironolactona 50<span class="elsevierStyleHsp" style=""></span>mg diarios&#44; desarroll&#243; hipotensi&#243;n sintom&#225;tica cuatro d&#237;as despu&#233;s de cambiar de ramipril a olmesart&#225;n &#40;por su m&#233;dico de cabecera&#41;&#46; Se suspendi&#243; el olmesart&#225;n y se control&#243; la HTA con minoxidil y espironolactona&#46; La otra paciente era una mujer de 71 a&#241;os cuyo tratamiento previo con losart&#225;n se suspendi&#243; debido al buen control de su HTA con minoxidil 2&#44;5<span class="elsevierStyleHsp" style=""></span>mg diarios&#46; El resto de pacientes no refirieron cambios o alteraciones de su HTA durante el tratamiento con MODB&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Arritmia</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se incluyeron un total de 10 pacientes &#40;8 mujeres y 2 hombres&#41; con una mediana de edad de 61 a&#241;os &#40;rango 37-74&#41;&#46; De ellos&#44; se titul&#243; la dosis de MODB en tres pacientes&#44; lo que permiti&#243; analizar 15 dosis&#46; La mediana de la dosis de MODB fue de 0&#44;75<span class="elsevierStyleHsp" style=""></span>mg &#40;rango 0&#44;25-5&#41; y la mediana de la duraci&#243;n fue de 5 meses &#40;rango 1-11&#41;&#46; La indicaci&#243;n m&#225;s frecuente para el tratamiento con MODB fue la alopecia androgen&#233;tica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#44; seguida del efluvio tel&#243;geno cr&#243;nico &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#44; y la alopecia frontal fibrosante &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Nueve pacientes ten&#237;an antecedentes personales de arritmia&#44; entre ellas&#44; extras&#237;stole supraventricular &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; fibrilaci&#243;n auricular &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; taquicardia sinusal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; s&#237;ncope cardiaco &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y arritmia desconocida &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44; faltaban datos&#41;&#46; De ellos&#44; cuatro pacientes estaban bajo tratamiento m&#233;dico con betabloqueantes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; o amiodarona &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; dos pacientes se hab&#237;an sometido a una ablaci&#243;n card&#237;aca&#44; un paciente ten&#237;a un marcapasos y dos pacientes no recib&#237;an ning&#250;n tratamiento&#46; El paciente restante ten&#237;a una v&#225;lvula a&#243;rtica mec&#225;nica debido a un aneurisma a&#243;rtico reparado por el procedimiento de Bentall&#46; De estos 10 pacientes&#44; en cinco de ellos se realiz&#243; una consulta con el cardi&#243;logo antes de iniciar el tratamiento con MODB&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">S&#243;lo se notificaron EA sist&#233;micos en un paciente con extras&#237;stole supraventricular en tratamiento con carvedilol que desarroll&#243; edema periorbitario y de pies con MODB 1<span class="elsevierStyleHsp" style=""></span>mg&#44; que se resolvi&#243; tras ajustar la dosis a 0&#44;25<span class="elsevierStyleHsp" style=""></span>mg&#46; Ning&#250;n paciente notific&#243; palpitaciones&#44; empeoramiento de su arritmia previa ni ning&#250;n otro EA cardiol&#243;gico&#44; y ninguno de ellos requiri&#243; una modificaci&#243;n de su tratamiento m&#233;dico previo&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">Hasta donde sabemos&#44; &#233;ste representa el primer estudio sobre la seguridad del MODB en pacientes con HTA o arritmia&#46; Numerosos estudios han demostrado su perfil de seguridad favorable en poblaci&#243;n general<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#8211;4&#44;6</span></a> y estudios recientes han investigado el uso de MODB en situaciones especiales como en la poblaci&#243;n pedi&#225;trica<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>&#44; adolescente<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> y anciana<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a>&#44; pero hay escasos datos de su uso en pacientes con HTA o arritmia&#46; La prevalencia global de HTA en adultos es del 34&#37;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a>&#44; por lo que parece importante ampliar el conocimiento sobre el manejo y los aspectos de seguridad del tratamiento con el MODB en estos pacientes&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En nuestra cohorte de pacientes hipertensos tratados con el MODB&#44; la frecuencia global y el tipo de EA fueron consistentes con los encontrados en estudios recientes<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">2&#8211;4</span></a>&#46; Se detectaron EA en el 21&#44;9&#37; de los casos&#44; y la hipertricosis fue el m&#225;s frecuente &#40;15&#44;9&#37;&#41;&#44; de forma similar a los datos encontrados por Va&#241;o-Galv&#225;n et al<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a>&#46; Sin embargo&#44; encontramos una mayor frecuencia de EA cardiovasculares &#40;mareo y retenci&#243;n de l&#237;quidos&#41;&#44; y m&#225;s pacientes que presentaron m&#225;s de 1 EA &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">El mareo y la taquicardia se asociaron significativamente con un mayor riesgo tanto de ajuste como de suspensi&#243;n del MODB &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; La hipertricosis se asoci&#243; al ajuste de dosis pero no a la suspensi&#243;n&#44; lo que apoya que este EA suele ser bien tolerado&#46; Los pacientes tratados con tres o m&#225;s f&#225;rmacos antihipertensivos presentaron un mayor riesgo de mareo y de suspensi&#243;n del MODB&#46; Entre todos los f&#225;rmacos antihipertensivos&#44; la doxazosina provoc&#243; un mayor riesgo de mareo&#44; retenci&#243;n de l&#237;quidos y suspensi&#243;n del MODB&#46; Esto podr&#237;a explicarse por el hecho de que la doxazosina es un bloqueante alfaadren&#233;rgico que tambi&#233;n provoca vasodilataci&#243;n arteriolar<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a>&#44; lo que podr&#237;a producir un efecto sin&#233;rgico con el minoxidil&#46; Aunque podr&#237;a ser plausible que otros vasodilatadores&#44; como la hidralazina o los antagonistas del calcio&#44; aumentaran este efecto sin&#233;rgico con el minoxidil&#44; no encontramos una asociaci&#243;n estad&#237;sticamente significativa&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El mareo &#40;tambi&#233;n denominado v&#233;rtigo o hipotensi&#243;n postural&#41; fue el EA sist&#233;mico m&#225;s frecuente y la causa m&#225;s com&#250;n tanto de ajuste como de interrupci&#243;n del MODB &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; En general fue leve y se notific&#243; con mayor frecuencia en verano y por la ma&#241;ana&#46; No hubo casos de hipotensi&#243;n grave ni de alteraci&#243;n del control de la presi&#243;n arterial &#40;PA&#41;&#46; A este respecto&#44; dos estudios recientes investigaron la variaci&#243;n de la PA en pacientes varones tratados con 5<span class="elsevierStyleHsp" style=""></span>mg de MODB mediante monitorizaci&#243;n ambulatoria de la PA durante 24<span class="elsevierStyleHsp" style=""></span>h&#46; Encontraron una ligera reducci&#243;n de la PA en las 2<span class="elsevierStyleHsp" style=""></span>h posteriores a la toma de MODB <a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> y en la semana 24<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a>&#46; Pocos estudios adicionales han evaluado la PA durante el tratamiento con MODB a dosis entre 0&#44;45 y 5<span class="elsevierStyleHsp" style=""></span>mg&#44; obteniendo resultados similares<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#8211;17</span></a>&#46; Esto concuerda con estudios de los a&#241;os setenta con minoxidil de 2&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#44; 5<span class="elsevierStyleHsp" style=""></span>mg y 10<span class="elsevierStyleHsp" style=""></span>mg que encontraron un efecto hipotensor m&#237;nimo o nulo en pacientes normotensos<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">La retenci&#243;n de l&#237;quidos &#40;principalmente edema de pies&#59; s&#243;lo 2 casos de edema facial&#41; se detect&#243; en nuestro estudio en el 2&#44;6&#37; de los pacientes&#44; lo que supone una frecuencia ligeramente superior a la de estudios previos en poblaci&#243;n general<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; pero muy inferior al tratamiento con dosis est&#225;ndar &#40;7&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>&#46; No encontramos una frecuencia inferior en los pacientes que tomaban diur&#233;ticos como antihipertensivos &#40;tiazidas o espironolactona&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La taquicardia solo se detect&#243; en el 0&#44;8&#37; de los pacientes con hipertensi&#243;n arterial&#44; requiriendo todos ellos ajuste o suspensi&#243;n del MODB&#46; La taquicardia es el resultado de una activaci&#243;n simp&#225;tica refleja inducida por el efecto vasodilatador del minoxidil oral&#44; y tradicionalmente se describe como un EA frecuente con la dosis est&#225;ndar<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>&#46; Sin embargo&#44; los estudios con el MODB han demostrado que las palpitaciones son bastante infrecuentes y transitorias&#44; apareciendo generalmente dentro de las primeras tomas del MODB<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">4&#44;7&#44;15&#44;17</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los cambios en el electrocardiograma son otro EA com&#250;n con la dosis est&#225;ndar de minoxidil&#44; presentando cambios en la direcci&#243;n y en la magnitud de las ondas T hasta en el 60&#37; de los pacientes&#44; debido principalmente a un mecanismo de robo coronario asociado a la reducci&#243;n de la presi&#243;n arterial en las arterias coronarias&#46; Son asintom&#225;ticas y suelen desaparecer a pesar de la continuaci&#243;n del tratamiento<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>&#46; Solo en pocos estudios se han realizado electrocardiogramas en pacientes con MODB&#46; Un estudio realizado en Tailandia encontr&#243; cambios asintom&#225;ticos en la onda T en el 10-20&#37; de los pacientes &#40;inversi&#243;n de la onda T no isqu&#233;mica en una derivaci&#243;n&#41;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a>&#46; Sanabria et al&#46; encontraron un aumento no significativo en la aparici&#243;n de extras&#237;stole supraventricular y ventricular despu&#233;s de 24 semanas de tratamiento con 5<span class="elsevierStyleHsp" style=""></span>mg del MODB&#44; sin alteraciones notables en la repolarizaci&#243;n ventricular en la monitorizaci&#243;n Holter de 24<span class="elsevierStyleHsp" style=""></span>h<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">De manera interesante&#44; en esta cohorte de pacientes con arritmia&#44; ning&#250;n paciente inform&#243; palpitaciones o empeoramiento de su enfermedad previa&#46; A estos pacientes no se les realiz&#243; un electrocardiograma de rutina&#44; pero cinco de ellos fueron remitidos a su cardi&#243;logo&#44; quien aprob&#243; el tratamiento con MODB&#46; Sin embargo&#44; se debe extremar la precauci&#243;n en pacientes con enfermedad coronaria o insuficiencia card&#237;aca cr&#243;nica&#44; ya que la taquicardia puede limitar la oxigenaci&#243;n del miocardio &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">De manera consistente con aquellos estudios previos de MODB&#44; no se detect&#243; ning&#250;n EA cardiovascular grave&#44; como la presencia de s&#237;ncopes&#44; cardiopat&#237;a isqu&#233;mica&#44; pericarditis o derrame peric&#225;rdico&#46; Estos EA se describieron con dosis est&#225;ndar de minoxidil&#44; pero ocurrieron principalmente en pacientes con enfermedades de base como el lupus eritematoso sist&#233;mico&#44; la enfermedad renal avanzada o insuficiencia card&#237;aca congestiva&#44; y son extremadamente raros con el MODB<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Bas&#225;ndonos en nuestros resultados&#44; la experiencia cl&#237;nica de los autores en el tratamiento del MODB y la colaboraci&#243;n de un cardi&#243;logo en este estudio &#40;MR&#41;&#44; la mayor&#237;a de los pacientes sometidos a tratamiento para la HTA pueden iniciar MODB sin necesidad de derivaci&#243;n previa al cardi&#243;logo&#46; Sin embargo&#44; sugerimos algunas recomendaciones para el manejo de la terapia MODB en pacientes con HTA o arritmia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Las limitaciones de este estudio fueron el dise&#241;o retrospectivo&#44; la ausencia de un grupo control y la ausencia de la medici&#243;n objetiva de la presi&#243;n arterial y la realizaci&#243;n de ECG&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el tratamiento con el MODB demostr&#243; un perfil de seguridad favorable en pacientes con HTA o arritmia&#44; similar al de la poblaci&#243;n general&#46; Los EA sist&#233;micos m&#225;s frecuentes fueron el mareo y la retenci&#243;n de l&#237;quidos&#44; que mejoraron tras el ajuste o la retirada del MODB&#46; La combinaci&#243;n de MODB con 3 o m&#225;s f&#225;rmacos antihipertensivos o con doxazosina se asoci&#243; con un mayor riesgo de estos EA sist&#233;micos&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Los autores declaran que no tienen ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        9 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflicto de intereses"
        ]
        10 => array:1 [
          "titulo" => "Referencias"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-06-23"
    "fechaAceptado" => "2023-07-20"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1764142"
          "palabras" => array:7 [
            0 => "Alopecia androg&#233;nica"
            1 => "Hipotensi&#243;n"
            2 => "Hipertensi&#243;n arterial"
            3 => "Presi&#243;n arterial"
            4 => "Alopecia"
            5 => "Arritmia"
            6 => "Cardiopat&#237;a"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1764141"
          "palabras" => array:7 [
            0 => "Androgenetic alopecia"
            1 => "Hypotension"
            2 => "Arterial hypertension"
            3 => "Blood pressure"
            4 => "Hair loss"
            5 => "Arrhythmia"
            6 => "Heart disease"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Antecedentes y objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los efectos adversos sist&#233;micos son una de las principales limitaciones del uso de minoxidil oral a dosis bajas &#40;MODB&#41;&#44; especialmente en pacientes con hipertensi&#243;n arterial o arritmias&#46; El objetivo de este estudio fue evaluar la seguridad de MODB en estos pacientes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo multic&#233;ntrico con pacientes con antecedentes de hipertensi&#243;n o arritmias tratados con MODB para cualquier tipo de alopecia&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; un total de 254 pacientes con hipertensi&#243;n &#40;176 mujeres &#91;69&#44;3&#37;&#93; y 78 hombres &#91;30&#44;7&#37;&#93;&#41; con una edad media de 56&#44;9 a&#241;os &#40;rango 19 &#8211; 82&#41;&#46; La dosis de MODB se increment&#243; gradualmente en 128 pacientes&#44; obteniendo un total de 382 dosis analizadas&#46; Los sujetos estaban tomando de media 1&#44;45 f&#225;rmacos antihipertensivos &#40;rango 0 &#8211; 5&#41;&#46; Se detectaron EA sist&#233;micos en 26 casos &#40;6&#44;8&#37;&#41;&#44; incluyendo mareo &#40;3&#44;1&#37;&#41;&#44; retenci&#243;n de l&#237;quidos &#40;2&#44;6&#37;&#41;&#44; malestar general &#40;0&#44;8&#37;&#41;&#44; taquicardia &#40;0&#44;8&#37;&#41; y cefalea &#40;0&#44;5&#37;&#41;&#44; requiriendo suspensi&#243;n del MODB en seis casos &#40;1&#44;5&#37;&#41;&#46; Los pacientes en tratamiento con doxazosina &#40;p &#60; 0&#44;001&#41; o con tres o m&#225;s antihipertensivos &#40;p &#61; 0&#44;012&#41; presentaron mayor riesgo de suspensi&#243;n de MODB&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con MODB mostr&#243; un perfil de seguridad favorable en pacientes con hipertensi&#243;n o arritmias&#44; similar al de la poblaci&#243;n general&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Material y m&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Systemic adverse effects &#40;AE&#41; are a major concern of low-dose oral minoxidil &#40;LDOM&#41; treatment&#44; especially in patients with arterial hypertension or arrhythmia&#46; The objective of this study was to evaluate the safety of LDOM in patients with hypertension or arrhythmia&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Retrospective multicenter study of patients with hypertension or arrhythmia treated with LDOM for any type of alopecia&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 254 patients with hypertension &#91;176 women &#40;69&#46;3&#37;&#41; and 78 men &#40;30&#46;7&#37;&#41;&#93; with a mean age of 56&#46;9 years &#40;range 19&#8211;82&#41; were included&#46; From them&#44; the dose of LDOM was titrated in 128 patients&#44; allowing the analysis of 382 doses&#46; Patients were receiving a mean of 1&#46;45 &#40;range 0&#8211;5&#41; antihypertensive drugs&#46; Systemic AE were detected in 26 cases &#40;6&#46;8&#37;&#41; and included lightheadedness &#40;3&#46;1&#37;&#41;&#44; fluid retention &#40;2&#46;6&#37;&#41;&#44; general malaise &#40;0&#46;8&#37;&#41;&#44; tachycardia &#40;0&#46;8&#37;&#41; and headache &#40;0&#46;5&#37;&#41;&#44; leading to LDOM discontinuation in 6 cases &#40;1&#46;5&#37;&#41;&#46; Prior treatment with doxazosin &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; or with three or more antihypertensive drugs &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;012&#41; was associated with a higher risk of discontinuation of LDOM&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">LDOM treatment showed a favorable safety profile in patients with hypertension or arrhythmia&#44; similar to general population&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1248
            "Ancho" => 2516
            "Tamanyo" => 312086
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Diagrama de flujo que describe el tipo y la frecuencia de los efectos adversos&#44; el ajuste de la dosis y la interrupci&#243;n del tratamiento con MODB en pacientes hipertensos&#46;&#42; La suma de las frecuencias individuales puede diferir de la frecuencia total porque algunos pacientes desarrollaron m&#225;s de un efecto adverso&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2355
            "Ancho" => 2518
            "Tamanyo" => 734609
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Recomendaciones para el manejo de la terapia con MODB en pacientes con hipertensi&#243;n o arritmia &#40;basadas en la experiencia cl&#237;nica de los autores y los resultados de este estudio&#41;&#46; <span class="elsevierStyleSup">a</span> Comentario del cardi&#243;logo&#58; el dermat&#243;logo puede considerar disminuir la dosis o cambiar la hora de ingesta del medicamento antihipertensivo anterior si el paciente desarrolla mareos&#46; <span class="elsevierStyleSup">b</span> Contraindicaciones seg&#250;n la monograf&#237;a del producto minoxidil&#46; <span class="elsevierStyleSup">c</span> Comentario del cardi&#243;logo&#58; El MODB podr&#237;a utilizarse despu&#233;s de un infarto de miocardio s&#243;lo una vez que se haya alcanzado un estado estable despu&#233;s del infarto &#40;12 meses despu&#233;s&#41;&#46; No usar si se trata de angina no revascularizada&#47;evento isqu&#233;mico&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">ECA&#58; enzima convertidora de angiotensina&#59; EA&#58; efectos adversos&#59; BRA&#58; antagonistas de los receptores de la angiotensina II&#59; MODB&#58; minoxidil oral en dosis bajas&#59; El valor de p se considera estad&#237;sticamente significativo si &#60;0&#44;05 &#40;negrita&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Requiere la interrupci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Total</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">382&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&#47;382 &#40;3&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#47;382 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;367&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;352&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">277 &#40;72&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12&#47;277&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#47;277&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombre&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">105 &#40;27&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#47;105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#47;105&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad&#44; media &#40;rango&#41;&#44; a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56&#46;9 &#40;19&#8211;82&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58&#46;79 years &#40;45&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61&#46;33 years &#40;49&#8211;70&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Minoxidil &#40;MODB&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dosis&#44; media &#40;rango&#41;&#44; mg&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;59 &#40;0&#46;2&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duraci&#243;n&#44; media &#40;rango&#41;&#44; meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span> MODB en combinaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">353 &#40;92&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#47;353&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span> MODB en monoterapia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">187 &#40;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;187&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Efectos Adversos &#40;EA&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84 &#40;21&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;1 EA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;1&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;024</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hipertricosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61 &#40;15&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#47;61<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;651&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ca&#237;da intensa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">EA Sist&#233;micos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mareo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retenci&#243;n de l&#237;quidos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malestar general&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cefalea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#225;s de 1 EA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">1&#46;9&#37;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Suspensi&#243;n de MODB</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;08&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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