Title:Hypertension and Heart Failure with Preserved Ejection Fraction: Connecting the Dots
Volume: 16
Issue: 1
Author(s): Costas Tsioufis*, Georgios Georgiopoulos, Dimitrios Oikonomou, Costas Thomopoulos, Niki Katsiki, Alexandros Kasiakogias, Christina Chrysochoou, Dimitrios Konstantinidis, Theodoros Kalos and Dimitrios Tousoulis
Affiliation:
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens,Greece
Keywords:
Hypertension, heart failure, preserved ejection fraction, diastolic, dysfunction, blood pressure.
Abstract: 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.