Therapeutic Principles in Hypertension Management in Patients with Congestive Heart Failure and Coronary Artery Disease

Systemic hypertension (HTN) is the most common identifiable risk factor for the development of cardiovascular diseases (CVD). Epidemiological studies have shown strong association between elevated arterial blood pressure (BP) and the development of coronary artery disease (CAD), stroke cerebrovascular accident, renal failure, aortic dissection, peripheral arterial disease (PAD), and heart failure (HF)�[1] There is enough evidence to suggest that lowering BP has a significant impact on morbidity and mortality.[2] Out of all CV disorders, CAD and HF contribute to the majority of deaths. Thus, prevention, early detection, and control of HTN are of paramount importance. HTN is aptly classified as Stage A HF because of their strong association. Treatment of HTN in patients with HF must take into consideration the type of HF that is present: HF with reduced ejection fraction (HFrEF), in which systolic function is impaired; or HF with preserved ejection fraction (HFpEF), in which diastolic function is impaired but systolic function is preserved� Management guidelines are well established for HFrEF, but less certain for HFpEF� HF patients are nearly evenly divided between those with reduced left ventricular (LV) systolic function and those with preserved LV systolic function. Elderly hypertensives are more prone to HF� Any increase in BP above 120 mmHg systolic or 85 mmHg diastolic is associated with increased risk of developing CAD and eliminating this risk factor is a major concern of primary prevention�[3] Long-standing BP elevations promote endothelial injury, resulting in impaired nitric oxide (vasodilator) release and increased release of inflammatory mediators that promote the development of atherosclerosis and vascular occlusion. Uncontrolled HTN is also responsible for the occurrence of acute coronary events in patients with chronic stable angina�