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Hypertension and heart failure: a dysfunction of systole, diastole or both?

G W Yip1, J W H Fung, Y-T Tan

  • 1Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.

Journal of Human Hypertension
|November 28, 2008
PubMed

Insights

Hypertension causes pathological myocardial hypertrophy, leading to systolic and diastolic heart failure. Addressing factors beyond heart muscle dysfunction, like chronotropic incompetence, may improve exercise capacity in these patients.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Heart Failure Studies

Background:

  • Pathological myocardial hypertrophy in hypertension seeds maladaptive cardiac development.
  • Factors like impaired coronary perfusion, fibrosis, and abnormal ventricular function contribute to systolic and diastolic dysfunction.
  • Chronotropic incompetence and peripheral factors (vasodilator reserve, arterial compliance) impact cardiac output, especially during exercise.

Purpose of the Study:

  • To explore the spectrum of heart failure in hypertensive patients, viewing distinct phenotypes as part of a continuum.
  • To highlight the limitations of dichotomizing heart failure into systolic and diastolic entities, impacting clinical trial development.
  • To identify potential therapeutic targets beyond cardiac dysfunction for improved patient outcomes.

Main Methods:

  • Review of existing evidence on myocardial hypertrophy, ventricular remodeling, and functional abnormalities in hypertensive heart disease.
  • Analysis of commonalities between hypertensive heart failure with normal ejection fraction and systolic heart failure.
  • Examination of the role of chronotropic incompetence and peripheral vascular function in exercise capacity.

Main Results:

  • Hypertensive heart failure encompasses a spectrum of ventricular remodeling and volume changes, not distinct entities.
  • Many underlying pathological factors are shared across different heart failure presentations in hypertensive individuals.
  • Current therapeutic approaches may be limited by focusing solely on systolic and diastolic dysfunction.

Conclusions:

  • Hypertensive heart failure is a complex disorder involving more than just cardiac muscle function.
  • Therapies targeting myocardial fibrosis, enhancing vasodilator reserve, and improving chronotropic incompetence warrant further investigation.
  • Addressing peripheral factors and exercise response may lead to more effective treatments for hypertensive heart failure patients.

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