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Hypertension and Heart Failure with Preserved Ejection Fraction: Connecting the Dots
Costas Tsioufis1, Georgios Georgiopoulos1, Dimitrios Oikonomou2
1First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens. Greece.
Insights
Hypertension is a major risk factor for heart failure with preserved ejection fraction (HFpEF). Controlling blood pressure through medication and lifestyle changes is key for HFpEF prevention and treatment.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Heart failure with preserved ejection fraction (HFpEF) constitutes 50% of heart failure cases, with increasing prevalence.
- Hypertension (HT) is the most common comorbidity in HFpEF, contributing to its pathogenesis and prognosis.
- HT represents a significant modifiable risk factor for HFpEF.
Purpose of the Study:
- To review epidemiologic data on the co-aggregation of HFpEF and HT.
- To explore pathophysiologic mechanisms linking HT to HFpEF.
- To assess treatment strategies targeting HT for HFpEF prevention and management.
Main Methods:
- Literature review of epidemiologic and pathophysiologic studies.
- Analysis of evidence for antihypertensive medications in HFpEF.
- Evaluation of non-pharmacological interventions for blood pressure control.
Main Results:
- Antihypertensive medications show variable efficacy in HFpEF patients.
- No single antihypertensive treatment has demonstrated significant survival benefit.
- Non-pharmacological approaches like renal denervation and lifestyle modifications aid blood pressure control.
Conclusions:
- Optimal blood pressure management is crucial for HFpEF.
- Pharmacological and non-pharmacological strategies are essential for BP control in HFpEF.
- Further research, including trials on novel drugs like LCZ696, is needed to establish definitive treatments.
Introduction:
Heart failure (HF) with preserved ejection fraction (EF) (HFpEF) accounts for approximately 50% of HF cases and its prevalence relative to HF with reduced EF is rising. Hypertension (HT) is the most common co-morbidity in HFpEF patients and it is implicated in both the pathogenesis and the prognosis of the disease. Therefore, HT is a modifiable risk factor of high yield in HFpEF. We reviewed the literature for epidemiologic data supporting the co-aggregation of the two entities as well as patho-physiologic mechanisms linking HT to HFpEF. Most importantly, we focused on treatment options targeting HT as a preventive strategy for delaying the progression of diastolic dysfunction or decreasing the odds for developing HFpEF.
Conclusion:
Along this line, we summarized the evidence and efficacy associated with different classes of antihypertensive medications in HFpEF patients. Finally, non-pharmacological approaches, including renal denervation and lifestyle modifications, to achieve optimal blood pressure (BP) control in HFpEF patients are reported. Unfortunately, no specific antihypertensive treatment has established a major survival benefit in this high risk subjects. Until the results of the efficacy of the novel drug LCZ696 (valsartan/ sacubitril) are available, the continuous monitoring and lowering of the BP by pharmacological and non-pharmacological means should be considered the major preventive and treatment strategy in HFpEF patients.