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

• Published in: Journal of human hypertension Vol. 23; no. 5; pp. 295 - 306
• Main Authors: Yip, G W, Fung, J W H, Tan, Y-T, Sanderson, J E
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-05-2009; Nature Publishing Group
• Subjects: Adaptation, Physiological; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Cardiac patients; Cardiology. Vascular system; Cardiomyopathy, Hypertrophic - diagnosis; Cardiomyopathy, Hypertrophic - epidemiology; Cardiomyopathy, Hypertrophic - physiopathology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Clinical trials; Comorbidity; Congestive heart failure; Coronary artery disease; Diastole; Disease Progression; Echocardiography - methods; Ejection fraction; Epidemiology; Fibrosis; Fibrosis - diagnosis; Fibrosis - epidemiology; Fibrosis - physiopathology; Health Administration; Health aspects; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart rate; Humans; Hypertension; Hypertension - diagnosis; Hypertension - epidemiology; Hypertension - physiopathology; Hypertrophy; Hypertrophy, Left Ventricular - diagnosis; Hypertrophy, Left Ventricular - epidemiology; Hypertrophy, Left Ventricular - physiopathology; Medical sciences; Medicine; Medicine & Public Health; Oxygen consumption; Perfusion; Phenotypes; Physical training; Public Health; review; Risk factors; Stroke Volume; Systole; Ventricle; Ventricular Dysfunction - diagnosis; Ventricular Dysfunction - epidemiology; Ventricular Dysfunction - physiopathology; Ventricular Remodeling; United Kingdom; volume overload; remodelling; heart failure; pressure overload; Hypertension; Heart failure; Diastole; Heart disease; Cardiovascular disease; Systole
• ISSN: 0950-9240; 1476-5527
• DOI: 10.1038/jhh.2008.141

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.