The role of arterial hypertension in development heart failure with preserved ejection fraction: just a risk factor...

Area of Science:

• Cardiology
• Internal Medicine
• Hypertension Research

Background:

• Heart failure with preserved ejection fraction (HFpEF) lacks a clear definition and understanding of its pathophysiology.
• Arterial hypertension is common in HFpEF, but its exact role (risk factor vs. essential condition) remains unclear.
• Shared biohumoral systems (renin-angiotensin-aldosterone, sympathetic nervous system, oxidative stress) link hypertension and HFpEF.

Purpose of the Study:

• To review the available data on the pathophysiology and mechanisms connecting hypertension and HFpEF.
• To discuss current investigations and therapeutic approaches for both conditions.
• To highlight the need to resolve the predisposition of hypertensive patients to develop HFpEF.

Main Methods:

• Review of existing literature on HFpEF and arterial hypertension.
• Analysis of pathophysiological links and shared mechanisms.
• Evaluation of current diagnostic and therapeutic strategies.

Main Results:

• Large trials of standard HFpEF therapies (RAAS inhibitors, diuretics, CCBs, beta-blockers) have not demonstrated efficacy.
• Studies often lack consistent HFpEF definitions, with left ventricular ejection fraction (LVEF) cut-offs varying (40-50%).
• Cardiovascular and all-cause mortality reduction has not been consistently shown in HFpEF patients.

Conclusions:

• The relationship between hypertension and HFpEF is complex, involving shared pathophysiological pathways.
• Current therapeutic strategies for HFpEF have limited proven benefit.
• Further research is needed to clarify HFpEF definition, pathophysiology, and identify effective treatments, particularly in hypertensive populations.