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Management of hypertension in chronic heart failure

Saraswathy Manickavasagam1, Ramanna Merla, Michael M Koerner

  • 1University of Texas Medical Branch, 301 University Boulevard 5,106 John Sealy Annex, Galveston, TX 77555-0553, USA.

Expert Review of Cardiovascular Therapy
|April 22, 2009
PubMed

Insights

Managing hypertension in chronic heart failure (CHF) patients requires careful drug selection. First-line agents with proven mortality benefits in CHF should be prioritized, while others should be avoided.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Chronic heart failure (CHF) impacts millions, leading to frequent hospitalizations and high mortality.
  • Hypertension (HTN) is a major risk factor for HF, preceding it in 75% of cases.
  • HF presents as either reduced left ventricular systolic function or preserved systolic function (diastolic dysfunction).

Purpose of the Study:

  • To review the management of essential hypertension in patients at risk for, or with, chronic heart failure.
  • To discuss the latest developments in managing both hypertension and heart failure.

Main Methods:

  • Review of current therapeutic strategies for hypertension in heart failure patients.
  • Analysis of drug classes with proven mortality benefits and those to be avoided.
  • Consideration of differences in hypertension management based on ejection fraction.

Main Results:

  • First-line agents for HTN in CHF include beta-blockers, ACE inhibitors, ARBs, aldosterone blockers, hydralazine, and nitrates.
  • Alpha-receptor blockers should be avoided due to increased mortality risk in HF.
  • Dihydropyridine calcium channel blockers have a neutral effect on mortality and can be used for refractory HTN.

Conclusions:

  • Optimal management of hypertension in CHF involves prioritizing drugs with demonstrated mortality benefits.
  • Treatment strategies for hypertension differ between HF with reduced ejection fraction and HF with preserved ejection fraction.
  • Ongoing research aims to identify novel treatments benefiting both hypertension and heart failure.

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