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Managing hypertension in patients with heart failure: an ongoing quandary

Tripti Gupta1, Tameem Rezan1, Selim R Krim2,3,4

  • 1Department of Internal Medicine, Ochsner Medical Center.

Current Opinion in Cardiology
|May 3, 2019
PubMed

Insights

Hypertension management in heart failure patients requires individualized care based on left ventricular function. Angiotensin receptor-neprilysin inhibitors show promise for better blood pressure control in heart failure with reduced ejection fraction.

Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Hypertension (HTN) is a major risk factor for heart failure (HF), affecting up to 91% of newly diagnosed HF patients.
  • Effective management of HTN in HF patients is crucial for improving outcomes.

Purpose of the Study:

  • To provide a practical approach to managing hypertension in patients with heart failure.
  • To review current evidence and guidelines for antihypertensive therapy in HF.

Main Methods:

  • Review of current literature and clinical guidelines on HTN management in HF.
  • Analysis of data regarding the efficacy of various antihypertensive drug classes.

Main Results:

  • No randomized trials specifically compare antihypertensive regimens in HF.
  • Guideline-directed medical therapy (GDMT) including ACEis, ARBs, beta-blockers, and aldosterone blockers should be maximized in HF with reduced ejection fraction (HFrEF) regardless of BP.
  • ACEis and aldosterone blockers are suggested as first-line for HTN in HF with preserved ejection fraction (HFpEF).

Conclusions:

  • AT1 neprilysin inhibitors demonstrate superior BP control compared to ACEis or ARBs in HFrEF and are recommended as first-line therapy.
  • The role of AT1 neprilysin inhibitors in HFpEF is promising but requires further investigation.
Abstract

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