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Management of hypertension in heart failure: striking lack of evidence for a common problem

Jagdish C Mohan1, Vipul Mohan

  • 1Department of Cardiology, Ridge Heart Centre, Sunder Lal Jain Hospital, Ashok Vihar-III, Delhi 110052, India. jcmohan@vsnl.com

Indian Heart Journal
|February 17, 2009
PubMed

Insights

Hypertension frequently coexists with heart failure, particularly heart failure with normal ejection fraction (HFnEF). This review addresses the lack of HFnEF guidelines and offers new recommendations for managing this common comorbidity.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Heart Failure Management

Background:

  • Arterial hypertension is a frequent concomitant and pathogenetic factor in both systolic heart failure and heart failure with normal ejection fraction (HFnEF).
  • Hypertension is more prevalent in HFnEF patients than in systolic heart failure patients in community settings.
  • Acute heart failure presentations exhibit a higher frequency of co-existent hypertension.

Purpose of the Study:

  • To review the existing literature on the common co-occurrence of hypertension and heart failure, especially HFnEF.
  • To highlight the absence of specific guidelines for managing HFnEF.
  • To address contradictory recommendations in managing co-existing hypertension and heart failure.

Main Methods:

  • A comprehensive review of available scientific literature.
  • Analysis of studies focusing on the combined management of arterial hypertension and heart failure.
  • Examination of current guidelines for hypertension and systolic heart failure management.

Main Results:

  • Separate guidelines exist for hypertension and systolic heart failure, but not for HFnEF.
  • Contradictory drug management recommendations are noted for co-existing hypertension and heart failure.
  • Hypertension is highly prevalent in HFnEF, exceeding its prevalence in systolic heart failure.

Conclusions:

  • The management of co-existing hypertension in heart failure, particularly HFnEF, requires specific attention due to guideline gaps.
  • New recommendations are proposed for the effective management of this prevalent clinical combination.
  • Further research is needed to clarify optimal therapeutic strategies for patients with hypertension and HFnEF.

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