Hypertension (HTN) and in particular, uncontrolled and resistant hypertension, is common in patients with chronic kidney disease (CKD), yet large-scale data on the characteristics of patients with CKD and inadequately controlled HTN are sparse. This study aims to analyze and compare the clinical profiles of patients with CKD who exhibit inadequately controlled blood pressure (BP) while on treatment with at least two antihypertensive medications, against those whose BP is well-controlled under similar treatment conditions. The EnligHTN study is an observational database study using data from claims and health registries to assess the burden of inadequately controlled HTN. This analysis included data from IQVIA Ambulatory EMR linked with IQVIA PharMetrics® Plus in US (data from other countries will be added later). A total of 8,397 patients diagnosed with CKD and HTN and treated with ≥2 antihypertensive drugs between 2018–2023 were included. CKD was defined as either ≥2 eGFR measures ≥90 days apart, both <60 mL/min/1.73 m2, or a recorded diagnosis of: CKD; end-stage renal disease; hypertensive CKD; diabetic CKD; glomerular diseases; or renal tubulo-interstitial diseases. Patients were considered inadequately controlled if their first office BP (oBP) measurement was above BP target (130/80 mmHg) while being treated with ≥2 antihypertensive drugs for at least 30 days (index). Patient characteristics at index were summarized by oBP control status. Among patients with CKD treated with ≥2 antihypertensive drugs, 65% had inadequately controlled HTN. Patients with inadequately controlled HTN had a mean oBP of 139/82 mmHg, mean age of 60 (standard deviation (SD): 11) years and 56% were male. Patients with controlled HTN had a mean oBP of 116/69 mmHg, mean age of 62 (SD: 11) years and 54% were male. The average number of antihypertensive drugs was similar in both groups (2.4 vs. 2.5). The most prevalent comorbidities in patients with inadequately controlled and controlled HTN were dyslipidemia (63% and 66%, respectively), obesity (62% and 54%, respectively) and type 2 diabetes (44% and 49%, respectively). A higher proportion of patients whose HTN was controlled were taking sodium-glucose cotransporter 2 inhibitors (8% vs 5%) and statin (52% vs 45%) medications at index, compared to CKD patients with inadequately controlled HTN. Two thirds of the patients with CKD who were treated with at least 2 antihypertensive drugs had inadequately controlled BP. Comorbidities were commonly present in both those with and without BP at target level. This indicates a significant burden of uncontrolled BP in patients with CKD and comorbid HTN.

Background: Despite the availability of various treatment options, uncontrolled hypertension (HTN) remains prevalent, significantly increasing risks of cardiorenal disease and mortality, and underscores the urgency of greater engagement from healthcare providers and burden for healthcare systems. We aimed to characterize healthcare resource utilization (HCRU) among patients with uncontrolled HTN across several countries. Methods: In this multi-country database cohort study, data from Telotròn (Spain (ESP)), IQVIA Ambulatory EMR linked with IQVIA PharMetrics® Plus claims (US), Clinical Practice Research Datalink (UK) and Meuhedet (Israel (ISR)) from 2018 to 2023 were used, with data anticipated from additional countries. Patients were included if they had a diagnosis of HTN and their first blood pressure (BP) measurement; were being treated with ≥2 antihypertensive medications for ≥30 days (index date) and were above the BP target (US: ≥130/80 mmHg; UK, ESP, and ISR: ≥140/90 mmHg), indicating uncontrolled HTN. Patient characteristics and all-cause HCRU were analyzed descriptively. Results: A total of 199,167 patients with uncontrolled HTN were included (Table 1). The mean age ranged from 56.9 – 67.2 years and 40.6% – 46.9% were female. Mean age was the highest in ISR (67.2 years; standard deviation (SD) 11.9) and lowest in the US (56.9 years; SD 11.5). General practice visit rates were highest in ISR, followed by the UK, ESP and the US. The number of outpatient specialist visits ranged from 2.31 (95%CI 2.28, 2.35) in ESP to 7.11 (6.92, 7.30) per person per year (PPPY) in ISR. The number of hospital admissions ranged between 0.56 (95%CI; 0.53, 0.59) in ESP and 1.52 in the UK (95%CI; 1.51, 1.53) PPPY with mean number of days hospitalized between 3.58 (95%CI; 3.57, 3.59) and 8.85 (95%CI; 8.63, 9.07) PPPY. Lastly, the number of emergency department visits varied the most between the US (1.20 (95%CI; 1.15, 1.26)) and ISR (0.48 (95%CI; 0.46, 0.50)). Conclusions: Uncontrolled HTN is associated with a substantial burden on healthcare resources. Patterns of HCRU varied across countries, likely reflecting differences in healthcare systems, clinical practice, definitions of uncontrolled HTN and patient demographics.

Introducción La anticoagulación oral (ACO) es clave en la tromboprofilaxis de la fibrilación auricular (FA), pero España carece de evidencia relevante en el mundo real. Nuestro objetivo fue analizar la prevalencia, las características clínicas y los patrones de tratamiento en los pacientes con FA en tratamiento con ACO, utilizando el procesamiento del lenguaje natural (PLN) y el aprendizaje automático (ML). Material y métodos Se realizó un estudio retrospectivo en los pacientes con FA en tratamiento con ACO de 15 hospitales españoles (2014-2020). Utilizando EHRead® (incluyendo PNL y ML) y SNOMED_CT, extrajimos y analizamos los datos demográficos de los pacientes, las comorbilidades y el tratamiento con ACO de las historias clínicas electrónicas. Se estimó la prevalencia de FA y se realizó un análisis descriptivo. Resultados De los 4.664.224 pacientes de nuestra cohorte, la prevalencia de FA osciló entre el 1,9 y el 2,9%. Se incluyeron un total de 57.190 pacientes en tratamiento con ACO, de los cuales el 80,7% recibía antagonistas de la vitamina K (AVK) y el 19,3% ACO de acción directa (ACOD). La mediana de edad fue de 78 y 76 años, respectivamente, y los varones constituyeron el 53% de la cohorte. Las comorbilidades como hipertensión arterial (76,3%), diabetes (48,0%), insuficiencia cardíaca (42,2%) y enfermedad renal (18,7%) fueron frecuentes, y más frecuentes en los usuarios de AVK. Más del 50% tenía una puntuación alta de CHA2DS2-VASc. El cambio de tratamiento más frecuente fue de ACOD a acenocumarol (58,6 al 70,2%). En los cambios de AVK a ACOD, apixabán fue el más elegido (35,2%). Conclusiones Utilizando PNL y ML para extraer la RWD, establecimos la cohorte española más completa de pacientes con FA tratados con ACO hasta la fecha. El análisis reveló una alta prevalencia de FA, complejidad de los pacientes y una marcada preferencia por AVK sobre el ACOD. Es importante destacar que, en las transiciones de AVK a ACOD, apixabán fue la opción preferida.

Abstract Background Limited evidence exists regarding real-world practices and outcomes of oral anticoagulation in patients with Non-Valvular Atrial Fibrillation (NVAF). Purpose To conduct a retrospective real-world data (RWD) study using Natural Language Processing (NLP) and Machine Learning (ML) on Electronic Health Records (EHRs) to evaluate the efficacy and safety of Direct Oral Anticoagulants (DOACs) and vitamin K antagonists (VKAs) in NVAF patients. Methods Retrospective study in 15 Spanish hospitals between 2014-2020 including adult NVAF patients treated with oral anticoagulants without anticoagulation history, recent thrombotic events, rheumatic mitral valvular heart disease, mitral valve stenosis, venous thromboembolism, nor pregnancy. We employed EHRead®, a free text analysis engine utilizing NLP and ML to extract RWD from EHRs based in SNOMED CT (standardized coding system). Free-text information was extracted and organized in an anonymized database for population-based descriptive and comparative analysis. After matching patients using propensity-score matching (PSM), we used Kaplan-Meier curves to compare VKA vs DOAC efficacy on thrombotic prevention, safety, and mortality. Results After evaluating 138,773,332 EHRs from 4.6 million patients, 44,292 NVAF patients were included; 35,267 (79.6%) treated with VKA and 9,025 (20.4%) with DOAC. Half of them were men (53.0%) with a mean (SD) age of 76.3 (12.7) years. VKA-treated patients tended to be older, with more cardiovascular comorbidities and higher CHA2DS2-VASc scores than DOACs-treated patients (Table 1). Using PSM, 8,930 patients were matched per subgroup with standardized mean differences below 10% for all confounders. The comparative analysis showed that DOAC-treated patients had a significant lower risk of thrombotic, minor bleeding events, and mortality than VKA-treated ones, with no significant differences in major bleeding (Figure 1). Conclusion The application of NLP and ML allowed us to create an extensive, plausible, and detailed database of Spanish NVAF patients from RWD in EHRs. In our cohort, we found a higher efficacy and lower mortality and minor bleeding events with DOACs over VKAs, without differences in major bleeding events. This study was sponsored by Pfizer and Bristol Myers Squibb. JCS, MA & CS were paid consultants to Pfizer and Bristol Myers Squibb in connection with the development of this abstract. CAC & LMS are employes of the SAVANA who were paid consultants to Pfizer and Bristol Myers Squibb in connection with the development of this abstract. DA & SFC are employees of Pfizer.Table 1Figure 1

IntroductionOral anticoagulation (OAC) is key in atrial fibrillation (AF) thromboprophylaxis, but Spain lacks substantial real-world evidence. We aimed to analyze the prevalence, clinical characteristics, and treatment patterns among patients with AF undertaking OAC, using natural language processing (NLP) and machine learning (ML).Materials and methodsThis retrospective study included AF patients on OAC from 15 Spanish hospitals (2014-2020). Using EHRead® (including NLP and ML), and SNOMED_CT, we extracted and analyzed patient demographics, comorbidities, and OAC treatment from electronic health records. AF prevalence was estimated, and a descriptive analysis was conducted.ResultsAmong 4,664,224 patients in our cohort, AF prevalence ranged from 1.9% to 2.9%. A total of 57,190 patients on OAC therapy were included, 80.7% receiving Vitamin K antagonists (VKA) and 19.3% Direct-acting OAC (DOAC). The median age was 78 and 76 years respectively, with males constituting 53% of the cohort. Comorbidities like hypertension (76.3%), diabetes (48.0%), heart failure (42.2%), and renal disease (18.7%) were common, and more frequent in VKA users. Over 50% had a high CHA2DS2-VASc score. The most frequent treatment switch was from DOAC to acenocoumarol (58.6% to 70.2%). In switches from VKA to DOAC, apixaban was the most chosen (35.2%).ConclusionsUtilizing NLP and ML to extract RWD, we established the most comprehensive Spanish cohort of AF patients with OAC to date. Analysis revealed a high AF prevalence, patient complexity, and a marked VKA preference over DOAC. Importantly, in VKA to DOAC transitions, apixaban was the favored option.

OBJECTIVES:Characterise the circumstances associated with death during admission of adults with Down syndrome (DS) and to identify predictors of mortality.PATIENTS AND METHODS:Observational study based on data on all emergent admissions of adults with DS to hospitals of the Spanish National Health System between 1997 and 2014. We analysed epidemiological and clinical variables.RESULTS:We analysed admissions of 11,594 adults with DS, mean age 47 years. 1715 patients died (15%), being the highest mortality (35%) in individuals aged 50-59. A past medical history of cerebrovascular disease (aOR 2.95 [2.30-3.77]) or cancer (aOR 2.79 [2.07-3.75]), gross aspiration's admission (aOR 2.59 [2.20-3.04]), immobility (aOR 2.31 [1.46-3-62]), and readmission within 30 days (aOR 2.43 [2.06-2.86]) were identified as predictors of mortality.CONCLUSIONS:Adults with DS have a high in-hospital mortality rate. The main predictors of death were cerebrovascular disease, cancer, early readmission, and conditions commonly associated with advanced dementia.

A common feature of dominant digital platforms is that they are integrated into a plurality of business lines, including the markets they organise or connect, so that they operate a platform and market their own goods and services on it. This dual role played by platforms in various digital markets, acting simultaneously as intermediaries and providers, has raised fears that it may be exploited by platforms to further entrench their dominance, frustrate competition and stifle innovation. Despite the introduction of novel terms, such as self-preferencing, we are actually facing a classic conflict of interest that can be addressed from different branches of the legal system.

IntroductionIn addition to an increased risk of thromboembolic complications, patients with atrial fibrillation (AF) are at risk for vascular events. Consequently, complete vascular protection is warranted in these patients.Areas coveredA narrative search was conducted on PubMed (MEDLINE), using the MeSH terms [Rivaroxaban] + [Atrial fibrillation] + [Cardiovascular] + [Vascular] + [Treatment]. Original data from clinical trials, prospective and retrospective studies, useful reviews and experimental studies, were selected.Expert opinionThe ROCKET-AF trial showed that rivaroxaban is effective in reducing the risk of stroke, with a lower risk of fatal and intracranial bleeding compared to warfarin. Remarkably, experimental data have provided a number of pathogenic mechanisms through which rivaroxaban could provide beneficial vascular properties beyond its antithrombotic activity. Moreover, in the AF population, additional to its ability to reduce the risk of thromboembolic complications, rivaroxaban is associated with a lower risk of myocardial infarction, major adverse cardiac and limb events, and vascular mortality in patients with diabetes, also attenuating renal impairment during follow-up. These findings suggest that rivaroxaban may provide a comprehensive vascular protection in patients with AF.

El TJUE ha reconocido recientemente la aplicabilidad a una operación de concentración ya realizada de las normas que sancionan el abuso de posición dominante. Esta sentencia no es un fenómeno aislado ni su trascendencia se limita al campo del control de la concentración empresarial, sino que, como será objeto de análisis en este trabajo, constituye una manifestación más del cambio de sentido que está experimentando en los últimos años la política antitrust y cuyo alcance aún está siendo objeto de definición.

INTRODUCTION:Atrial fibrillation (AF) cannot be considered an isolated disease. Patients with AF should be managed using a comprehensive approach that is not limited to stroke prevention.AREAS COVERED:In this manuscript, the potential role of AF as a vascular disease that is managed as part of a holistic approach was reviewed.EXPERT OPINION:The residual risk of stroke in patients with AF reaches 1-2% annually, despite appropriate anticoagulation therapy. Additionally, patients with AF may develop cognitive impairment through stroke-independent pathways. Furthermore, patients with AF may have a higher risk of developing atherosclerotic vascular disease in various vascular beds and chronic kidney disease; conversely, patients with atherosclerotic disease may have an increased risk of developing AF. AF should be considered a truly systemic vascular disease, since it brings together several hemodynamic and systemic changes, including inflammation, oxidative stress, activation of the renin-angiotensin-aldosterone and sympathetic systems, as well as a prothrombotic state and endothelial dysfunction. In this regard, patients with AF should be treated based on a holistic approach that is not limited to oral anticoagulation but includes complete vascular protection.

Antecedentes y objetivosLa estimación del riesgo cardiovascular en personas mayores de 70 años es problemática. La mayoría de las escalas se han creado basándose en cohortes de personas de mediana edad, con una representación insuficiente de los adultos de más edad. El poder predictivo de los factores de riesgo cardiovascular clásicos disminuye con la edad. El objetivo de este estudio es desarrollar una escala específica para estimar el riesgo cardiovascular de la población anciana española.MétodosEste estudio se realizó en una cohorte poblacional establecida en 1995. Marco: 3 zonas geográficas de España (Madrid, Ávila y Lugo). Participantes: 3.729 personas mayores de 64 años sin enfermedades cardiovasculares (ECV) al inicio del seguimiento. Mediciones: se investigaron anualmente las sospechas de ECV mortal y no mortal (cardiopatía coronaria e ictus) y se confirmaron usando los criterios del proyecto MONICA de la OMS. Se siguió a todos los participantes hasta que apareció el primer episodio de ECV, hasta su muerte o hasta el 31 de diciembre de 2015.ResultadosLa edad fue el factor predictivo más potente de ECV a los 10 años en ambos sexos. Las variables asociadas con ECV en los varones fueron el tratamiento de la hipertensión arterial (HR: 1,35; IC 95%: 1,067-1,710), la diabetes (HR: 1,359; IC 95%: 0,997-1,852) y el tabaquismo (HR: 1,207; IC 95%: 0,945-1,541), y en las mujeres, el tabaquismo (HR: 1,881; IC 95%: 1,356-2,609) y la diabetes (HR: 1,285; IC 95%: 0,967-1,707). El colesterol total no aumentó el riesgo de ECV ni en varones ni en mujeres. Sin embargo, las concentraciones de colesterol total>200mg/dL se asociaron inversamente al riesgo de ECV a los 10 años, tanto en varones como en mujeres.ConclusionesLa ECV total a los 10 años aumenta significativamente en los varones españoles de edad avanzada con la edad, la diabetes y el tratamiento antihipertensivo, y en las mujeres con la diabetes y el tabaquismo. Los niveles de colesterol total no aumentaron el riesgo de ECV, sobre todo en los varones.

Background : Cardiovascular risk estimation in people over 70 years is problematic. Most scores have been derived from cohorts of middle-aged people, with older persons under-represented. The predictive power of classical cardiovascular risk factors reduce with age. The aim is to develop a specific score for the elderly population Methods : Population-based cohort established in 1995. Setting: Three geographical areas of Spain (Madrid, Ávila and Lugo). Participants: 3,729 people older than 64 years, free of any cardiovascular diseases (CVD), at baseline. Measurements: Suspected fatal and nonfatal CVD (both coronary heart disease and stroke) were yearly investigated and confirmed using the WHO-MONICA criteria. All participants were followed until the occurrence of the first CVD event, until death or until December 31th 2015 if alive. Results : Age was the strongest predictor of 10-year CVD both in men and women. In men, variables associated to CVD were high blood pressure treatment (HR: 1,35; 95% CI: 1,067 , 1,710), diabetes (HR: 1,359; 95% CI: 0,997 , 1,852) and smoking (HR:1,207; 95%CI: 0,945 , 1,541), and in women smoking (HR: 1,881 95%CI: 1,356 , 2,609) and diabetes (HR:1,285; 95%CI:0,967 , 1,707). Total-cholesterol did not increased the risk of CVD either in males or females. However, total-cholesterol level (>200mg/dl) were negatively associated both in men and women. Conclusions : In old Spanish men, 10-year total CVD is significantly increased by age, diabetes and antihypertensive treatment, and in old women by diabetes and smoking. Total-cholesterol levels did not increased the risk of CVD either in males or females.

OBJECTIVES:To describe the clinical and epidemiological characteristics of adult patients with Down syndrome admitted to Spanish hospitals between 1997 and 2014. Secondary goals were to study trend changes over time, and to analyse differences between patients admitted to medical and surgical departments.PATIENTS AND METHODS:Retrospective observational study on data collected from the Minimum Basic Dataset (MBDS, Conjunto Mínimo Básico de Datos [CMBD]) of admissions of adults with Down syndrome to hospitals belonging to the Spanish National Health System from 1 January 1997 through 31 December 2014. We analysed epidemiological and clinical variables.RESULTS:We analysed 28,716 admissions of 16,874 adult patients with Down syndrome. Men accounted for 58.2% of the sample, and the mean age on admission was 41 ± 13 years, with an 11-year increase in mean age during the study period. Admissions among persons with Down syndrome increased by 5% during the study period, with a noticeable rise in admissions of older adults and to medical departments. Almost one-third of patients (31.8%) were admitted more than once. Age-adjusted mortality was 15.7%. The most common comorbid conditions were chronic obstructive pulmonary disease (25%), hypothyroidism (18.6%), and epilepsy (14.3%). The departments with the highest numbers of admissions were internal medicine (26.3%), pulmonary medicine (6.9%), and general surgery (5.25%).CONCLUSION:Hospital admissions among Spanish adults with Down syndrome have increased in recent decades, especially in older patients. We identified substantial differences between patients admitted to medical and surgical departments.

This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were included. A total of 1089 patients were analyzed, of whom 65.3% had only IHD, 17.8% PAD and 16.9% both. A total of 80.6% were taking only one antiplatelet agent, and 18.2% were on dual antiplatelet therapy (mainly aspirin/clopidogrel). Almost all patients were taking ≥1 lipid lowering drug, mainly moderate-to-high intensity statins. IHD patients took ezetimibe more commonly than PAD (43.9% vs. 12.9%; p < 0.001). There were more patients with IHD that achieved blood pressure targets compared to PAD (<140/90 mmHg: 67.9% vs. 43.0%; p < 0.001; <130/80 mmHg: 34.1% vs. 15.7%; p < 0.001), LDL-cholesterol (<70 mg/dL: 53.1% vs. 41.5%; p = 0.033; <55 mg/dL: 26.5% vs. 16.0%; p = 0.025), and diabetes (HbA1c < 7%, with SGLT2i/GLP1-RA: 21.7% vs. 8.8%; p = 0.032). Modifications of antihypertensive agents and lipid-lowering therapy were performed in 69.0% and 82.3% of patients, respectively, without significant differences between groups. The use of SGLT2i/GLP1-RA was low. In conclusion, cardiovascular risk factors control remains poor among patients with IHD, PAD, or both. A higher use of combined therapy is warranted.

Some patients with COVID-19 pneumonia develop an associated cytokine storm syndrome that aggravates the pulmonary disease. These patients may benefit of anti-inflammatory treatment. The role of colchicine in hospitalized patients with COVID-19 pneumonia and established hyperinflammation remains unexplored. In a prospective, randomized controlled, observer-blinded endpoint, investigator-initiated trial, 240 hospitalized patients with COVID-19 pneumonia and established hyperinflammation were randomly allocated to receive oral colchicine or not. The primary efficacy outcome measure was a composite of non-invasive mechanical ventilation (CPAP or BiPAP), admission to the intensive care unit, invasive mechanical ventilation requirement or death. The composite primary outcome occurred in 19.3% of the total study population. The composite primary outcome was similar in the two arms (17% in colchicine group vs. 20.8% in the control group; p = 0.533) and the same applied to each of its individual components. Most patients received steroids (98%) and heparin (99%), with similar doses in both groups. In this trial, including adult patients with COVID-19 pneumonia and associated hyperinflammation, no clinical benefit was observed with short-course colchicine treatment beyond standard care regarding the combined outcome measurement of CPAP/BiPAP use, ICU admission, invasive mechanical ventilation or death (Funded by the Community of Madrid, EudraCT Number: 2020-001841-38; 26/04/2020).

Introducción: Este artículo analiza el Programa ARSUIC como un registro objetivo a través del cual podemos estudiar las conductas suicidas, permitiéndonos a través de su examen estudiar los mecanismos y factores que influyen en la aparición de la conducta suicida en población Infanto-juvenil. Métodos: Estudio retrospectivo de base hospitalaria conducido entre 2017 y 2019 , en dónde se recogen los casos de menores de 18 años atendidos por conducta suicida en la red de recursos de psiquiatría del Hospital Universitario Infanta Cristina. Resultados: Se extrajeron 39 ARSUIC que cumplían criterios de inclusión del estudio. La media de edad registrada fue de 16,61 años. Se contempló disparidad entre los distintos sexos, siendo el 74,36% de los casos niñas. En cuanto al tipo de conducta se observó que un 69,23% fueron intoxicaciones medicamentosas, un 10,26% gestos autolesivos, un 17,95% ideaciones autolíticas y un 2,56% ingesta de cáusticos. Del total de casos, sólo el 25,64% presentaron conductas reincidentes. Dentro de los determinantes biológicos de salud se encontró que el 33,33% presentaba algún tipo de comorbilidad y el 30,77 % antecedentes familiares en salud mental. Con respecto a los factores sociales se advirtió que un 38,46 % de la muestra correspondía a niños migrantes y que el 23,08% de los niños pertenecían a familias que presentaban algún tipo de problemática socioeconómica grave. Conclusiones: A pesar de que se trata de una muestra pequeña hemos se han descrito los determinantes de salud en sujetos menores de 18 años que presentaron conducta suicida en nuestra área de salud.

Una de las cuestiones más controvertidas en relación a la aplicación de las normas de competencia a empresas pluricorporativas es la eventual utilización del principio de unidad económica como vía de extensión de responsabilidad entre las distintas sociedades. Actualmente, asistimos a una nueva inquietud que valora la extensión de responsabilidad aguas abajo, es decir, la posible legitimación pasiva de la filial para soportar el ejercicio de una acción follow on por una infracción cometida por su matriz y por la que ella no ha sido sancionada. La cuestión es objeto de un encendido debate doctrinal y judicial entre defensores de una responsabilidad del grupo como tal y posturas más apegadas a las categorías tradicionales de imputación de responsabilidad. El objeto de este trabajo es el examen de dicho debate y la valoración crítica de las diferentes posiciones y argumentos utilizados.

espanolEn las economias occidentales se ha venido observando en las ultimas decadas un paulatino incremento del grado de concentracion de los mercados unido al surgimiento y consolidacion de empresas con significativas posiciones de poder economico. Esta situacion es especialmente evidente en los mercados digitales. La aparicion y consolidacion de las grandes plataformas tecnologicas ha reavivado una discusion largo tiempo adormecida sobre los valores que a las normas de defensa de la libre competencia compete promover y tutelar, volviendo a traer el derecho antitrust a la arena politica y, en el caso estadounidense, a sus propios origenes. EnglishIn western economies, a gradual increase in the degree of market concentration has been observed in recent decades, together with the emergence and consolidation of companies with significant positions of economic power. This situation is especially evident in digital markets. The emergence and consolidation of large technological platforms has rekindled a long dormant discussion about the values that the antitrust law is responsible for promoting and protecting, bringing antitrust law back to the political arena and, in the case of the United States, to its own origins.

Una de las cuestiones más controvertidas en relación con la aplicación de las normas de competencia a empresas pluricorporativas es la eventual utilización del principio de unidad económica como vía de extensión de responsabilidad entre las distintas sociedades. Actualmente, asistimos a una nueva inquietud que valora la extensión de responsabilidad aguas abajo. Es decir, la posible legitimación pasiva de la filial para soportar el ejercicio de una acción follow on por una infracción cometida por su matriz y por la que ella no ha sido sancionada. La cuestión es objeto de un encendido debate doctrinal y judicial entre defensores de una responsabilidad del grupo como tal y posturas más apegadas a las categorías tradicionales de imputación de responsabilidad. El objeto de este trabajo es el examen de dicho debate y la valoración crítica de las diferentes posiciones y argumentos utilizados.