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Hypertension and diastolic heart failure

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Abstract

In patients with hypertension, pressure overload leads to left ventricular hypertrophy (LVH), myocardial fibrosis, and impaired diastolic filling without systolic dysfunction. Presently, diastolic heart failure accounts for about 50% of the heart failure population. Fatigue, dyspnea, reduced exercise tolerance, and peripheral edema are common presenting complaints. As a group, patients with diastolic heart failure are older and predominantly female. Diuretics are effective for treating congestive symptoms. β Blockers and heart rate-lowering calcium blockers show benefit in smaller studies but have not been evaluated in definitive clinical trials. Renin-angiotensin-aldosterone system blockers reduce blood pressure, LVH, and myocardial fibrosis; however, long-term studies with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers demonstrate little effect on symptoms or survival, and inconsistent effects on heart failure hospitalization. At present, evidence-based treatment includes antihypertensive therapy to reduce progression from hypertension to heart failure. In patients with established heart failure, diuretics and other empiric treatments are used to control symptoms.

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Authors and Affiliations

  1. Division of Cardiovascular Disease, The Western Pennsylvania Hospital, Suite 3411 NT, 4800 Friendship Avenue, Pittsburgh, PA, 15224, USA

    Alan H. Gradman

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  1. Alan H. Gradman
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  2. J. Travis Wilson
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Correspondence to Alan H. Gradman.

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Gradman, A.H., Travis Wilson, J. Hypertension and diastolic heart failure. Curr Cardiol Rep 11, 422–429 (2009). https://doi.org/10.1007/s11886-009-0061-5

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