Hypertension and Heart Failure: From Pathophysiology to Treatment

Area of Science:

• Cardiology
• Nephrology
• Endocrinology

Background:

• Hypertension is a primary risk factor for heart failure (HF) across all ejection fraction ranges.
• Adequate blood pressure (BP) control is proven to reduce cardiovascular events, including HF development.
• Current hypertension management in HF often extrapolates data from general hypertensive populations, not HF-specific studies.

Purpose of the Study:

• To clarify critical issues in hypertension management for heart failure (HF) patients, particularly regarding blood pressure (BP) targets.
• To review the role of various antihypertensive drugs and novel agents in managing hypertension in HF populations.
• To explore the BP-lowering effects of HF-indicated drugs like SGLT2 inhibitors and finerenone.

Main Methods:

• Review of existing evidence on hypertension and HF management.
• Analysis of drug classes with documented outcome benefits and BP-lowering effects.
• Examination of emerging therapies including SGLT2 inhibitors, finerenone, and small interfering RNA.

Main Results:

• Combination therapy is recommended for hypertension in HF with reduced ejection fraction (HFrEF).
• Major antihypertensive drug classes are recommended for HF with preserved ejection fraction (HFpEF).
• SGLT2 inhibitors and finerenone demonstrate beneficial BP-lowering actions and cardiovascular outcomes in HF contexts.

Conclusions:

• Optimizing BP targets in HF patients requires further research beyond general population data.
• Novel agents like SGLT2 inhibitors and finerenone show promise in managing hypertension and improving outcomes in HF.
• Emerging strategies like small interfering RNA warrant investigation for future hypertension and HF management.