The progression from hypertension to congestive heart failure

Abstract

Riassunto. L'ipertensione arteriosa rappresenta il principale fattore di rischio per lo sviluppo di malattie cardiovascolari e renali. Numerose e solide evidenze sono disponibili a sostegno dei beneficî derivanti dalla riduzione dei valori pressori in termini di riduzione del rischio di sviluppare infarto del miocardio, ictus cerebrale e morte per cause cardiovascolari. È importante sottolineare, tuttavia, come i pazienti affetti da ipertensione arteriosa abbiano anche un rischio aumentato di sviluppare insufficienza cardiaca, indipendentemente dalla presenza di ipertrofia o disfunzione ventricolare sinistra. È stato, inoltre, dimostrato come il controllo dei valori pressori determini una significativa riduzione del rischio di sviluppare questa complicanza. In particolare, studi di meta-analisi condotti nel corso degli ultimi anni hanno consentito di dimostrare come l'impiego di diuretici o di farmaci in grado di antagonizzare il sistema renina-angiotensina sia maggiormente efficace in termini di prevenzione dello sviluppo di insufficienza cardiaca rispetto a strategie basate su calcio-antagonisti e beta-bloccanti.Nel presente articolo verranno discussi ed analizzati i principali aspetti fisiopatologici coinvolti nella progressione dall'ipertensione arteriosa allo scompenso cardiaco e le possibili strategie terapeutiche in grado di ridurre o prevenire tale progressione.Parole chiave. Ipertensione arteriosa, prevenzione cardiovascolare, scompenso cardiaco, terapia antiipertensiva.The progression from hypertension to congestive heart failure. Summary.Arterial hypertension still represents one of the major modifiable risk factors for cardiovascular and renal disease. Solid evidences are available demonstrating the large and significant benefits deriving from blood pressure lowering therapies in terms of reduced incidence of major cardiovascular events, including myocardial infarction, ischemic stroke and cardiovascular death. It should be also noted, however, that hypertensive patients are at increased risk of developing congestive heart failure, being this risk substantially independent by the concomitant presence of left ventricular hypertrophy or dysfunction. Indeed, it has been demonstrated that blood pressure reduction and control significantly reduce the risk of developing congestive heart failure. In particular, several recent meta-analyses have demonstrated that the use of diuretics and renin-angiotensin system blockers is superior to calcium-antagonists and betablockers in terms of prevention of new-onset heart failure.The present paper overviews the main pathophysiological aspects of the progression from arterial hypertension to congestive heart failure and the potential therapeutic interventions able to reduce or prevent this progression.

Left ventricular mass and systolic dysfunction in essential hypertension

“…Hypertension is the most common risk factor for congestive heart failure in the general population, 31 and the risk is further increased in subjects with electrocardiographic 31,32 or echocardiographic 33 evidence of LV hypertrophy. Our results demonstrate a biological interaction between LV mass and subclinical systolic dysfunction at a preclinical stage of the hypertensive disease, which may contribute in part to the high risk of heart failure to which subjects with LV hypertrophy are exposed.…”

“…Our results demonstrate a biological interaction between LV mass and subclinical systolic dysfunction at a preclinical stage of the hypertensive disease, which may contribute in part to the high risk of heart failure to which subjects with LV hypertrophy are exposed. [31][32][33] Identification of early, subclinical LV systolic dysfunction might be of prognostic importance in hypertension, [4][5][6] though data are still lacking on the specific role of reduced midwall FS as a predictor of heart failure in humans. In this regard, an important role in the development of LV hypertrophy and failure in hypertension has been attributed to the renin-angiotensin system activation.…”

Fifty years of Framingham Study contributions to understanding hypertension

“…Survival following onset of hypertensive heart failure was bleak with only 24% of men and 31% of women surviving 5 years. 34 Thus hypertension was the most common predisposing factor for heart failure, contributing a large proportion of the cases in the general population (Table 4). It is likely that earlier and more aggressive blood pressure control offer the greatest promise for reducing the incidence of heart failure and its associated mortality.…”

Bioimpedance and New‐Onset Heart Failure: A Longitudinal Study of >500 000 Individuals From the General Population

“…Next, we assessed the relationships between the top 15 features associated with heart failure from the gradient boosting machine model and incident heart failure by using Cox proportional hazards regression in 2 sets of models: (1) adjusting for age and sex; and (2) additionally adjusting for body mass index, systolic and diastolic blood pressure, antihypertensive treatment, alcohol consumption, diabetes mellitus, smoking status, prevalent chronic renal failure, and prevalent coronary heart disease, all of which are established risk factors for heart failure 7, 8, 9, 10, 11. Continuous variables were entered as restricted cubic splines to account for any nonlinear associations.…”