From hypertension to heart failure

Abstract

The prevalence of heart failure is increasing in modern societies. Hypertension is a major contributor to the development of heart failure, whether through the development of left ventricular hypertrophy and diastolic dysfunction or by promoting atherosclerosis and myocardial infarction, which eventually leads to systolic dysfunction and left ventricular dysfunction. Effective therapy for hypertension can prevent more than 50% of heart failure events. Most studies done in the last three decades have used b blockers with diuretics as the modality of therapy. These agents have been shown to effectively prevent the development of heart failure. More recent comparative studies have shown that use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are also effective in preventing heart failure. Calcium channel blockers, however, seem to be less effective in preventing development of heart failure in patients with hypertension. It needs to be emphasized that the most important variable in preventing heart failure is the appropriate treatment of hypertension.

Figure 1

Cardiovascular complications of untreated hypertensions (N=500). Enceph=encephalopathy; MI=myocardial infarction; CHF=congestive heart failure. Adapted from J Chron Dis. 1955;1:33–42. ¹

Figure 2

Progression from hypertension to heart failure. LVH=left ventricular hypertrophy; MI=myocardial infarction; CHF=congestive heart failure; LV=left ventricular; HF=heart failure. Adapted from Arch Intern Med. 1996;156:1789–1796. ³

Figure 4

Risk reduction of heart failure in elderly hypertensives. EWPHE=European Working Party on High Blood Pressure; SHEP=Systolic Hypertension in the Elderly Program; STOP=Swedish Trial in Old Patients With Hypertension. Adapted from JAMA. 1996;275:1557–1562. ²

Figure 5

Fatal and nonfatal hospitalized heart failure. Systolic Hypertension in the Elderly Program study by age group. Adapted from JAMA. 1997;278:212–216. ¹⁴