Primary prevention of heart failure: an update

The prevalence of heart failure is increasing world-wide. Primary prevention is essential. There are no trials targeting primary prevention. This review will focus on recently published studies that support drug therapy and lifestyle modification of high risk patients.

Recent meta-analyses confirm the beneficial effect of ACE-inhibitors, angiotensin-receptor blockers, and diuretics and/or beta blockers in the prevention of heart failure. However, heart failure is increased in patients receiving calcium channel blockers when compared with those receiving ACE-Is and beta blockers. High adherence to antihypertensive therapy results in a significant reduction in heart failure. Targeting a systolic blood pressure of less than 120 mmHg compared with less than 140 mmHg in diabetic hypertensive patients does not appear to decrease the development of heart failure. Not smoking, maintaining a healthy weight, performing regular exercise, and maintaining a healthy diet decrease the incidence of heart failure.

Utilization of antihypertensive agents appears to be the best global strategy for the prevention of heart failure. ACE-inhibitors and angiotensin-receptor blockers remain excellent first line agents. A large proportion of heart failure risk is due to modifiable factors, which need to be identified and controlled. Smoking confers up to a two-fold risk for the development of heart failure in the elderly and should be aggressively targeted.