Management of hypertension in heart failure with preserved ejection fraction: is there a blood pressure goal?
Journal
Current opinion in cardiology
ISSN: 1531-7080
Titre abrégé: Curr Opin Cardiol
Pays: United States
ID NLM: 8608087
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
pubmed:
13
3
2021
medline:
29
6
2021
entrez:
12
3
2021
Statut:
ppublish
Résumé
Hypertension remains a leading risk factor for heart failure with preserved ejection fraction (HFpEF), and elevated blood pressure (BP) portends an adverse prognosis in patients with established HFpEF. We summarize current evidence for mechanisms linking hypertension to HFpEF and management of hypertension in HFpEF. Data suggest a complex, multifactorial pathophysiology driving the association between hypertension and HFpEF, including left ventricular hypertrophy, diastolic dysfunction, atrial dysfunction, coronary microvascular disease, endothelial dysfunction, myocardial injury and fibrosis. Although intensive BP control may attenuate these processes, this hypothesis has not been tested on clinical outcomes in a dedicated randomized controlled trial (RCT) in HFpEF. Antihypertensive therapies variably improve key surrogate markers in HFpEF, though BP reduction generally does not account for these benefits. Accordingly, BP targets are extrapolated from observational studies and RCTs testing heart failure therapies that affect BP in addition to dedicated RCT data in patients at elevated risk (without heart failure). Clinicians should recognize the risk of disease progression and poor outcomes associated with uncontrolled hypertension in HFpEF. Intensive BP control, preferably by therapies known to improve outcomes in heart failure, may slow key pathways in disease progression. Future RCTs testing intensified BP control strategies in HFpEF are warranted.
Identifiants
pubmed: 33709982
doi: 10.1097/HCO.0000000000000852
pii: 00001573-202107000-00008
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
413-419Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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