Current perspectives on systemic hypertension in heart failure with preserved ejection fraction

Hypertension is a major contributor to the development of heart failure with preserved ejection fraction (HFpEF). Our understanding of the epidemiology and pathophysiology of HFpEF in relation to hypertension has increased considerably in recent years. We now know that the pathophysiologic relationship between hypertension and HFpEF is more complex than simply the development of left ventricular hypertrophy and diastolic dysfunction and that there are multiple ways in which hypertension interacts with other comorbidities, the vasculature, and the heart to predispose to HFpEF. Although the treatment of HFpEF has been challenging, there is widespread agreement that control of systemic blood pressure is important in the management of these patients. Here we review the relationship between hypertension and HFpEF, focusing on (1) epidemiology and (2) pathophysiology of HFpEF in relation to hypertension; (3) prevention of HFpEF by controlling hypertension; and (4) established and novel therapeutics for hypertension in the setting of HFpEF.