Hypertension — still an important cause of heart failure?

Abstract

Hypertension has been the single most important risk factor for heart failure until the last few decades. Now, it is frequently claimed that atherosclerotic coronary artery disease dominates as the major underlying cause, and hypertension is of lesser importance. We here review evidence regarding the contribution of hypertension to heart failure in the recent decades. It is not possible, in our view, to be confident of the relative importance of hypertension and coronary artery disease since there are significant limitations in the available data. The often-questionable diagnostic criteria used in defining heart failure is one such limitation. The absence or inadequacy of blood pressure recordings over the years prior to a diagnosis of heart failure seriously hinders the reaching of firm conclusions in many reports. Extrapolations from aetiological observations in one racial group to those in other racial groups, and from highly selected study groups in tertiary referral centres to patients with heart failure in primary and secondary care, may not be justified. Finally, the situation of heart failure primarily due to impaired left ventricular diastolic function, where hypertension is a frequent precursor, is often ignored in discussions of aetiology. Our view is that hypertension remains and probably is the single most, important modifiable risk factor for cardiac failure in some races and countries, where the dominant cardiac abnormality is left ventricular diastolic dysfunction. The situation is less clear for patients with heart failure primarily due to left ventricular systolic dysfunction.

Prevalence, awareness, treatment and control of hypertension in Galicia (Spain) and association with related diseases

“…It is an important risk factor that predisposes to cardiovascular diseases, including cardiac failure, stroke, chronic renal failure or coronary artery disease. 1 Like other multifactorial human traits, HT is caused by the interplay of several different 'risk' genes and multiple environmental factors. The risk of acquiring HT increases with the number of affected relatives and with severity of HT in these relatives.…”

Nitric oxide synthase 3 deficiency limits adverse ventricular remodeling after pressure overload in insulin resistance

“…IR is a risk factor for congestive heart failure, independently of established risk factors including diabetes (19). Moreover, IR commonly clusters with other cardiovascular risk factors such as hypertension, a chronic state of pressure-overload that can lead to heart failure (20). We previously developed a mouse model of combined IR and pressure-overload, by feeding mice a high-fat diet (HFD) followed by transverse aortic constriction (TAC) (30).…”

Towards understanding the aetiology and pathophysiology of human hypertension: where are we now?

“…This is most evident for the common conditions that complicate hypertension, such as heart failure and atrial fibrillation. 10,11 If hypertension is indeed caused by, or causes a proinflammatory state, then other inflammatory markers apart from the CRP must also have a role in the pathogenesis of hypertension. Recently, Orakzai et al 12 showed a linear relationship between higher while blood cell counts (WCC) and systolic blood pressures in a Brazilian population.…”