Congestive heart failure: pathophysiology and management with special reference to systemic hypertension

The recognition and management of heart failure is based on the knowledge of the underlying disease and precipitating factors. The underlying causes are all cardiovascular whereas precipitating factors comprise both cardiac and a variety of noncardiac factors. The influence of hypertension on the development of heart failure is complex. Increased ventricular systolic pressure raises myocardial oxygen demand, resulting in ischemic heart syndromes and arrhythmias. Also, systemic hypertension leads to hypertrophy, resulting in systolic and diastolic function abnormalities. Generally, heart failure is controlled by treating the underlying cause, by removal of precipitating factors, and by treatment of failure itself. Heart failure therapy involves general measures, and pharmacological and surgical therapy. The pharmacological treatment involves the use of diuretics, vasodilators, and positive inotropic agents. In patients with heart failure and hypertension, arterial and mixed type vasodilators are the drugs of choice. Positive inotropic agents have to be used with care because of the potential induction or aggravation of myocardial ischemia. Interest in beta-adrenergic-blocking agents, especially those with ancillary properties similar to vasodilators, has recently surged and will continue to provoke more and more clinical research in an attempt to unravel the complexities of these cardiovascular diseases and their therapies.