Hypertension and Heart Failure

Hypertension is defined as blood pressure above 140/90 mmHg and is a leading cause for the development of heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).[1] Although equally prevalent in both the forms of heart failure, it remains more common in HFpEF patients with prevalence of up to 90%, compared to HFrEF.[2-4] Various guidelines have recommended not only different staging systems for hypertension but also the target blood pressure (BP) goals and therapeutic drug usage in specified populations. Although the target BP goals and therapeutic strategies for BP control in HF patients have been mentioned in different guidelines, robust data are still lacking. Most of the recommendations for optimal BP control in HF patients have been extrapolated from other high-risk populations where intensive BP control showed better long-term cardiovascular (CV) outcomes, however, at an increased risk of adverse effects. Chronic hypertension causes pressure overload leading to ventricular hypertrophy which is initial compensatory mechanism and preserves cardiac output. Subsequently, the left ventricle (LV) dilates as remodeling occurs and LV starts to decompensate. Remodeling occurs due to activation of reninangiotensin system, sympathetic nervous system, and deposition of extracellular matrix. Diastolic dysfunction or the so-called HFpEF is the primary manifestation of hypertensive heart failure. It is only in the later stages that dilated cardiomyopathy leading to HFrEF sets in. Long-term prognosis is poor with increased mortality in hypertensive patients with HF. Treating hypertension can significantly reduce incident of HF and HF hospitalization, especially in old population.[5-7]