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Heart failure in hypertension: prevention and treatment
Vasiliki V Georgiopoulou1, Andreas P Kalogeropoulos, Javed Butler
1Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA 30322, USA. vgeorgi@emory.edu
Insights
Preventing hypertension and prehypertension is crucial for reducing heart failure epidemic. Lifestyle changes and specific medications like diuretics are key to managing blood pressure and preventing heart failure complications.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Heart failure is a growing epidemic requiring effective prevention strategies.
- Hypertension is a major risk factor for heart failure, but many cases develop with prehypertension.
- Prehypertension and hypertension are highly prevalent, necessitating interventions to prevent blood pressure rise.
Purpose of the Study:
- To highlight the significance of hypertension and prehypertension in heart failure development.
- To emphasize the role of lifestyle modifications and pharmacological interventions in preventing heart failure.
- To guide the selection of appropriate antihypertensive medications for heart failure prevention.
Main Methods:
- Review of existing evidence on hypertension, prehypertension, and heart failure.
- Analysis of the impact of lifestyle modifications on blood pressure control.
- Evaluation of the efficacy of different antihypertensive drug classes in preventing heart failure.
Main Results:
- Hypertension and prehypertension are critical targets for heart failure prevention.
- Lifestyle interventions like weight loss, sodium restriction, and physical activity are vital.
- Diuretics and renin-angiotensin system modulators show promise in heart failure prevention.
Conclusions:
- Aggressive management of blood pressure, including prehypertension, is essential for curbing the heart failure epidemic.
- Lifestyle modifications are foundational, with specific medications playing a crucial role when needed.
- Tailoring antihypertensive treatment based on individual patient factors is vital for optimal outcomes in heart failure prevention.
Abstract:
The heart failure epidemic calls for urgent prevention efforts. Hypertension is present in the majority of individuals who develop heart failure and carries the highest population-attributable risk for heart failure together with coronary heart disease. Therefore, hypertension is a natural prime target for prevention interventions. However, a substantial proportion of heart failure develops among individuals with a systolic BP (SBP) level below current therapeutic target recommendations (140 mmHg or 130 mmHg for high-risk groups), which are accepted as 'normal' levels, underlining the importance of prehypertension for heart failure development. Prevalence and incidence of both hypertension and prehypertension are high. Efforts to prevent or attenuate BP rise could lead to a substantial reduction of complications, including heart failure development. Lifestyle modifications play a crucial role in preventing elevation of BP levels and better control of high BP. Weight loss, control of sodium intake and diet, and physical activity are essential steps towards this direction. However, when medications are needed to reduce BP levels, the selection of the appropriate agent is important not only for effective control of BP but also to reduce hypertension-related complications. Diuretics and renin-angiotensin system modulators seem to be the most effective agents for heart failure prevention according to the existing evidence. Patients with heart failure and hypertension should be treated for hypertension based on the same principles, although medication selection should take into account concomitant medications, other risk factors and type of heart failure (reduced vs preserved left ventricular ejection fraction).
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