January 19, 2010Open Access
View Full PaperHypertension as an Underlying Factor in Heart Failure With Preserved Ejection Fraction
Key Result
Early control of hypertension is crucial for preventing HF-PEF, as clinical trials of RAAS inhibitors in patients with established HF-PEF have failed to demonstrate morbidity and mortality benefits.
Structured PICO
P
Population
Patients with heart failure with preserved ejection fraction (HF-PEF) and hypertension
I
Intervention
Renin-angiotensin-aldosterone system (RAAS) inhibitors and early control of hypertension
Given the lack of proven effective therapies for established HF-PEF, early and effective control of hypertension is crucial to prevent its development.
Abstract
The unique pathophysiology of heart failure with a preserved ejection fraction (HF-PEF) and the involvement of hypertension in its development are only poorly understood. The upregulation of the renin-angiotensin-aldosterone system (RAAS) has been identified as a key pathologic pathway contributing to fibrosis, cardiomyocyte abnormalities, inflammation, and endothelial dysfunction, all of which have been implicated in the progression of hypertension to HF-PEF. In addition, pharmacologic inhibition of the RAAS has been shown in animal models of diastolic dysfunction and in clinical trials to reduce these deleterious processes and to improve diastolic function. Despite these data, clinical trials performed with RAAS inhibitors in patients with HF-PEF have failed to demonstrate morbidity and mortality benefits. To date, there is no proven effective therapy specifically for HF-PEF. The deleterious effects of hypertension on mechanisms underlying the development of HF-PEF underscore the importance of effective and early control of hypertension for the prevention of HF-PEF.