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  • Review Article
  • Special Issue: Current evidence and perspectives for hypertension management in Asia
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Blood pressure in heart failure management and prevention

Hypertension Research volume 46, pages 817–833 (2023)Cite this article

Abstract

Hypertension is a leading cause of heart failure and other cardiovascular diseases. Its role in the pathogenesis of heart failure with reduced ejection fraction (HFrEF) differs from that in heart failure with preserved ejection fraction (HFpEF). Moreover, rigorous blood pressure control may reduce the incidence of heart failure. However, once heart failure develops, prognosis is affected by blood pressure, which may differ between patients with and without heart failure. Therefore, the association between guideline-directed medical therapy (GDMT) for heart failure and its uptitration must be considered for blood pressure management and should not be overlooked. Heart failure medications affect the blood pressure and efficacy per baseline blood pressure value. This review discusses the potential mechanisms by which hypertension leads to HFrEF or HFpEF, the impact of hypertension on incident heart failure, and the recommended approaches for blood pressure management in patients with heart failure.

Comparison between patients with and without heart failure regarding blood pressure The association between CV events and SBP is linear in patients without heart failure; however, it becomes J-shaped or inverse linear in those with heart failure. The management of BP, including optimal BP or pharmacotherapy, differs between the two populations. ACEi angiotensin-converting enzyme inhibitors, ARB angiotensin II receptor blockers; ARNi angiotensin receptor-neprilysin inhibitors, BB beta-blockers, BP blood pressure, CV cardiovascular, DASH Dietary Approaches to Stop Hypertension, GDMT guideline-directed medical therapy, HF heart failure, HFrEF heart failure with reduced ejection fraction, MRA mineralocorticoid receptor antagonists, SBP systolic blood pressure, SGLT2i sodium-glucose cotransporter 2 inhibitors.

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Funding

This work was partially supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI (grant numbers 22K16147 and 22K16152).

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Authors and Affiliations

  1. Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Daichi Maeda, Taishi Dotare, Yuya Matsue, Tsutomu Sunayama & Tohru Minamino

  2. National Heart Centre, Singapore, Singapore

    Kanako Teramoto

  3. Department of Biostatistics, National Cerebral and Cardiovascular Center, Osaka, Japan

    Kanako Teramoto

  4. Saw Swee Hock School of Public Health, National University of Singapore & the National University Health System, Singapore, Singapore

    Jasper Tromp

  5. Duke-National University of Singapore, Singapore, Singapore

    Jasper Tromp

  6. Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

    Jasper Tromp

  7. Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan

    Tohru Minamino

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  1. Daichi Maeda
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Correspondence to Yuya Matsue.

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Conflict of interest

J.T. was supported by the National University of Singapore Start-up grant, the tier 1 grant from the Ministry of Education and the CS-IRG New Investigator Grant from the National Medical Research Council; received consulting or speaker fees from Daiichi-Sankyo, Boehringer Ingelheim, Roche Diagnostics and Us2.ai; and owns patent US-10702247-B2 unrelated to the present work. Y.M. received an honorarium from Otsuka Pharmaceutical Co, Novartis Pharma K.K., Bayer, Inc., and AstraZeneca and collaborative research grants from Pfizer Japan, Inc., Otsuka Pharmaceutical Co, EN Otsuka Pharmaceutical Co., Ltd., and Nippon Boehringer Ingelheim Co., Ltd. T.M. is an Associate Editor of Hypertension Research. The other authors have no other conflicts of interest to declare.

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Maeda, D., Dotare, T., Matsue, Y. et al. Blood pressure in heart failure management and prevention. Hypertens Res 46, 817–833 (2023). https://doi.org/10.1038/s41440-022-01158-x

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