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Hypertension and heart failure: a dysfunction of systole, diastole or both?

Journal of Human Hypertension volume 23, pages 295–306 (2009)Cite this article

Abstract

The pathological myocardial hypertrophy associated with hypertension contains the seed for further maladaptive development. Increased myocardial oxygen consumption, impaired epicardial coronary perfusion, ventricular fibrosis and remodelling, abnormalities in long-axis function and torsion, cause, to a varying degree, a mixture of systolic and diastolic abnormalities. In addition, chronotropic incompetence and peripheral factors such as lack of vasodilator reserve and reduced arterial compliance further affect cardiac output particularly on exercise. Many of these factors are common to hypertensive heart failure with a normal ejection fraction as well as systolic heart failure. There is increasing evidence that these apparently separate phenotypes are part of a spectrum of heart failure differing only in the degree of ventricular remodelling and volume changes. Furthermore, dichotomizing heart failure into systolic and diastolic clinical entities has led to a paucity of clinical trials of therapies for heart failure with a normal ejection fraction. Therapies aimed at reversing myocardial fibrosis, and targets outside the heart such as enhancing vasodilator reserve and improving chronotropic incompetence deserve further study and may improve the exercise capacity of hypertensive heart failure patients. Hypertension heart disease with heart failure is simply not a dysfunction of systole and diastole. Other peripheral factors including heart rate and vasodilator response with exercise may deserve equal attention in an attempt to develop more effective treatments for this disorder.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China

    G W Yip & J W H Fung

  2. Department of Cardiovascular Medicine, The Medical School, University of Birmingham, Edgbaston, Birmingham, UK

    Y-T Tan & J E Sanderson

Authors
  1. G W Yip
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  2. J W H Fung
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  3. Y-T Tan
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  4. J E Sanderson
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Correspondence to J E Sanderson.

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Search strategy and selection criteria

We searched MEDLINE using ‘hypertension’ as the key word in combination with, ‘heart failure’, ‘remodelling’, ‘pressure overload’, ‘volume overload’ and ‘echocardiography’. We searched all major cardiovascular journals: New England Journal of Medicine, The Lancet, Journal of the American Medical Association, Circulation, Journal American College of Cardiology, Heart and European Heart Journal for similar and related articles. Reference lists in key articles were searched to identify older publications. More than 200 articles were analysed.

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Yip, G., Fung, J., Tan, YT. et al. Hypertension and heart failure: a dysfunction of systole, diastole or both?. J Hum Hypertens 23, 295–306 (2009). https://doi.org/10.1038/jhh.2008.141

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  • DOI: https://doi.org/10.1038/jhh.2008.141

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