Hypertensive Heart Disease and HFpEF: What We Have Learned in the Last Decade

Area of Science:

• Cardiology
• Hypertension Research
• Heart Failure Studies

Background:

• Hypertension is the leading risk factor for heart failure (HF), particularly HF with preserved ejection fraction (HFpEF).
• Chronic pressure overload from hypertension causes left ventricular hypertrophy, fibrosis, and diastolic dysfunction, leading to HFpEF.
• HFpEF is increasingly understood as a multi-systemic syndrome involving inflammation and metabolic factors.

Purpose of the Study:

• To elucidate the mechanisms of hypertensive HFpEF.
• To highlight the role of integrated management strategies.

Main Methods:

• Review of existing literature on hypertensive heart disease and HFpEF.
• Analysis of factors contributing to myocardial remodeling in hypertensive HFpEF.
• Examination of the impact of blood pressure control on HFpEF prognosis.

Main Results:

• Hypertensive HFpEF involves complex interactions between pressure overload, neurohormonal activation, endothelial dysfunction, and cardiometabolic stress.
• Observational data suggest a reverse J-curve relationship for blood pressure, with uncontrolled levels linked to poor outcomes.
• Myocardial remodeling is exacerbated by systemic inflammation and comorbidities.

Conclusions:

• Hypertensive HFpEF results from the interplay of chronic pressure overload and cardiometabolic inflammation.
• Integrated management targeting blood pressure, comorbidities, and myocardial remodeling is essential.
• Optimizing blood pressure control is vital for improving prognosis in hypertensive HFpEF.