Heart failure clinical syndrome arising from any structural or functional cardiac condition is associated with a comparable number of expected life-years lost as many common types of cancer and is one of the major health care problems worldwide.
Heart failure represents the final common pathway of the clinical history of different cardiac diseases. Arterial hypertension has been long considered as one of the most common etiological conditions predisposing to the development of heart failure. Clinical studies showed that different antihypertensive strategies reduced the incidence of heart failure in hypertensive patients.
Hypertension can lead to left ventricle hypertrophy, diastolic or systolic dysfunction and overt heart failure. The remodeling of left ventricle can cause diastolic dysfunction without clinical signs or symptoms of heart failure. The results at our center show that age-specific criteria for diastolic left ventricle dysfunction were highly consistent across populations with an age-standardized prevalence of 22.4% v. 25.1% (p = 0.09). This emphasizes the importance of treatment in some patients prior to development of overt heart failure.
Diastolic heart failure is characterized by the symptoms and signs, a preserved ejection fraction and abnormal left ventricular diastolic function caused by a decreased left ventricle compliance and relaxation.
Hypertension with other risk factors for atherosclerosis may cause myocardial infarction. Post MI remodeling takes place, leading to systolic dysfunction. Progression will lead to heart failure, with decreasing ejection fraction. The majority of patients with heart failure and preserved ejection fraction have a history of hypertension. Hypertension induces a compensatory thickening of the ventricular wall in an attempt to normalize wall stress, which results in left ventricle concentric hypertrophy, which in turn decreases left ventricle compliance and left ventricle diastolic filling. There are no specific guidelines for treating diastolic heart failure, but pharmacological treatment should be directed at normalizing blood pressure, promoting regression of left ventricle hypertrophy, preventing tachycardia and treating symptoms of congestion.
Preventive strategies directed toward an early and aggressive blood pressure control are likely to offer the greatest promise for reducing the incidence of heart failure.
Arterial Hypertension 2011, vol. 15, no 5, pages 275–282