Time to reconsider the perception and management of hypertensive heart disease

Global, regional, and national burden of hypertensive heart disease among older adults in 204 countries and territories between 1990 and 2019: a trend analysis

“…HHD remains a major concern in the management of hypertension and an important public health challenge. [ 7 , 19 ] According to the GBD 2017 data, the number of individuals with HHD worldwide increased by more than 2-fold between 1990 and 2017, reaching 17.1 million with 925,675 deaths and 16.5 million DALYs. [ 8 ] These data have continued to increase globally, with 19.6 million prevalent cases, 1.16 million deaths, and 21.5 million DALYs in 2019.…”

“…In recent years, novel insight has been gained into the pathophysiology and diagnosis of HHD. [ 7 , 19 ] Beyond left ventricular hypertrophy, a spectrum of target-organ damage has been identified to play an important role in the development of HHD. [ 5 ] Indeed, left ventricular hypertrophy was found to be present in only around one-third of individuals in a pooled cohort of 37,700 treated and untreated hypertensive patients.…”

“…[ 34 ] Furthermore, innovative diagnostic approaches based on imaging and circulating biomarkers and supplemented with artificial intelligence applications and machine learning have been investigated to identify hypertensive patients with distinct myocardial remodeling phenotypes who are at higher risk of HHD. [ 19 ] Notably, the management of blood pressure is the cornerstone for the prevention of HHD and control of its burden. Following the successful SPRINT trial, [ 35 ] intensive blood pressure lowering to <130 mmHg was recommended in the 2017 guideline for management of hypertension published by the American College of Cardiology/American Heart Association.…”

Reassessing the management of hypertension: Time to prevent aldosterone‐mediated heart failure

“…Beyond chronic cardiac pressure overload, non-haemodynamic mechanisms are also involved in these structural and functional alterations. 3 In this article we propose that excessive aldosterone production is responsible for haemodynamically and non-haemodynamically mediated cardiac alterations in many patients with hypertension and therefore contributes to HF risk (Figure 1). Consequently, we also propose that it is time to think more about aldosterone excess in specific hypertensive populations as well to reposition mineralocorticoid receptor antagonists (MRAs) as the first-line treatment in some hypertensive patients to prevent cardiac alterations induced by excess aldosterone and reduce the risk of HF (Figure 1).…”

“…hypertensive heart disease [HHD]) and predispose to HF. Beyond chronic cardiac pressure overload, non‐haemodynamic mechanisms are also involved in these structural and functional alterations 3 …”