Hypertonie und Herzinsuffizienz

Hypertension and heart failure A close relationship between arterial hypertension and congestive heart failure is now beyond doubt. The risk to develop congestive heart failure is 2- to 3-fold increased in patients with hypertension. Since the prevalence of hypertension is high, hypertension is the main cause of heart failure in 39% of men and 59% of women. There are two different mechanisms leading to heart failure. On the one hand, hypertension is a risk factor for coronary artery disease and consequently for myocardial infarction. On the other hand, hypertension is followed by left ventricular hypertrophy which may injure the myocardium leading to firstly asymptomatic and subsequently symptomatic diastolic and systolic dysfunction. Antihypertensive therapy significantly reduces the risk of heart failure and of other cardiovascular diseases. All classes of drugs reduce blood pressure to a similar extent; however, reduction of heart failure has only been shown using diuretics and ß-blockers. Frequently, in patients with hypertension congestive heart failure is caused by diastolic dysfunction due to left ventricular hypertrophy. Since hypertrophy increases morbidity and mortality it should be treated. After occurrence of systolic dysfunction, the combination of an ACE-inhibitor, a ß-blocker and spironolactone is the therapy of choice in all patients with hypertension, as it is in normotensives. In hypertensive patients, blood pressure in the upper normal or borderline range should already be considered as elevated and, consequently, be lowered.