Author + information
- Received January 7, 2017
- Revision received April 19, 2017
- Accepted April 19, 2017
- Published online July 31, 2017.
- aDepartment of Cardiology and Clinical Research, Inselspital, Bern University Hospital, Bern, Switzerland
- bDepartment of Cardiology, Mount Sinai Health Medical Center, Icahn School of Medicine, New York, New York
- cJagiellonian University, Krakow, Poland
- dLeon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
- ↵∗Address for correspondence:
Dr. Franz H. Messerli, Department of Cardiology and Clinical Research, University Hospital, Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
Longstanding hypertension ultimately leads to heart failure (HF), and, as a consequence most patients with HF have a history of hypertension. Conversely, absence of hypertension in middle age is associated with lower risks for incident HF across the remaining life course. Cardiac remodeling to a predominant pressure overload consists of diastolic dysfunction and concentric left ventricular (LV) hypertrophy. When pressure overload is sustained, diastolic dysfunction progresses, filling of the concentric remodeled LV decreases, and HF with preserved ejection fraction ensues. Diastolic dysfunction and HF with preserved ejection fraction are the most common cardiac complications of hypertension. The end stage of hypertensive heart disease results from pressure and volume overload and consists of dilated cardiomyopathy with both diastolic dysfunction and reduced ejection fraction. “Decapitated hypertension” is a term used to describe the decrease in blood pressure resulting from reduced pump function in HF. Progressive renal failure, another complication of longstanding hypertension, gives rise to the cardiorenal syndrome (HF and renal failure). The so-called Pickering syndrome, a clinical entity consisting of flash pulmonary edema and bilateral atheromatous renovascular disease, is a special form of the cardiorenal syndrome. Revascularization of renal arteries is the treatment of choice. Most antihypertensive drug classes when used as initial therapy decelerate the transition from hypertension to HF, although not all of them are equally efficacious. Low-dose, once-daily hydrochlorothiazide should be avoided, but long-acting thiazide-like diuretics chlorthalidone and indapamide seem to have an edge over other antihypertensive drugs in preventing HF.
- antihypertensive therapy
- cardiorenal syndrome
- hypertensive heart disease
- left ventricular hypertrophy
- Pickering syndrome
Dr. Messerli has served as a consultant for Daiichi-Sankyo, Pfizer, Servier, WebMD, Ipca, ACC, Menarini, and Sandoz. Dr. Rimoldi has served as a consultant for Servier, Menarini, and Takeda. Dr. Bangalore has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received January 7, 2017.
- Revision received April 19, 2017.
- Accepted April 19, 2017.
- 2017 American College of Cardiology Foundation