[Arterial hypertension and heart failure]

Systemic hypertension is a condition that frequently occurs before the onset of heart failure; furthermore, left ventricular hypertrophy (LVH) is an important risk factor for the development of heart failure (HF). Many studies have demonstrated that a linear relationship exists between increasing values of LV mass and the relative risk of the development of congestive HF. Hypertrophy-hyperplasy of cardiomyocytes and endothelial cells leads to a reduction in coronary reserve and to cell death due to apoptosis or focal necrosis. This characteristic has been defined as 'load dependent myocyte dysfunction' and it is characterized both by structural dysfunctions with cell death and by functional alterations that are detectable early with the evaluation of myocardial function measuring the mid-wall shortening. The detection of extremely high myocardial growth is another factor that could help to make an early diagnosis of HF. The presence of 'load geometrical adaptation' markers, together with an early detection of systolic function anomalies that are often accompanied by diastolic modifications, could help to identify, in an early phase, patients who will develop symptomatic LV dysfunction; therefore, these patients can be intensively treated and undergo a specific follow-up.