Mechanisms of development of heart failure in the hypertensive patient

Hypertension is a major risk factor for the development of heart failure. Mechanisms which maintain normal function in the short term in the pressure overloaded heart have longer term deleterious effects. These include left ventricular (LV) hypertrophy and chronic activation of the adrenergic and renin-angiotensin systems. beta-Blocking agents are capable of blocking the adrenergic system and, to some extent, the renin-angiotensin system. They are therefore attractive in treating hypertension, both for preventing the development of abnormalities and for reversing established LV dysfunction and hypertrophy. Trials in heart failure have shown that these agents prevent progressive myocardial dysfunction, prevent and reverse remodelling and improve intrinsic systolic function. Non-selective beta-blocking agents appear to offer greater anti-adrenergic effects than selective ones. However, more research is needed, including direct comparisons of different agents.