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Salt, hypertension, vascular stiffness and diastolic dysfunction, what comes first?

Journal of Human Hypertension volume 29, pages 573–574 (2015)Cite this article

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Congestive heart failure (CHF) has become one of the most common forms of heart disease. It is particularly prevalent among older subjects. Although intuitively many health professionals associate CHF with reduced left ventricular function, at present this is not necessarily the case. Actually at least half of those with CHF, have it with preserved left ventricular function.1 This is mostly evident among the older subjects. Presumably, those who have had it because of a reduction in left ventricular function imposed by a previous infarction might have passed away along the way. Generally, it is believed that CHF with preserved ventricular function is the natural evolution of diastolic left ventricular dysfunction. This in turn is the natural evolution of the combination of age-related increase in blood pressure that usually occurs in the aging population. Typically, it is associated with an increase in the left ventricular mass, a process that can hardly be dissociated form the natural course of the development of hypertension, and is frequently associated with obesity and the metabolic syndrome, and diabetes mellitus.1, 2 In our society that consumes processed food, which is the major source of consumed salt, it should be taken for granted that whoever is obese consumes larger amounts of salt than necessary.

Age, obesity, metabolic abnormalities and hypertension are also frequently associated with increased large vessel stiffness. Increased aortic stiffness is now measured directly as a pulse wave velocity, which has not only become a marker but also a strong predictor of survival.3 One of the reasons may be that aortic stiffness may be one of the steps toward the development of left ventricular hypertrophy, then dysfunction and subsequently heart failure.

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  1. Department of Medicine, Hypertension Unit, Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel

    M Bursztyn

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Correspondence to M Bursztyn.

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Bursztyn, M. Salt, hypertension, vascular stiffness and diastolic dysfunction, what comes first?. J Hum Hypertens 29, 573–574 (2015). https://doi.org/10.1038/jhh.2015.2

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