Abstract
There are two major reasons why hypertension is an important risk factor for heart failure. The first is that an elevated blood pressure increases the wall stress in the left ventricle. The second is that hypertension, in a complex manner, contributes to the development of atheromatous vascular disease. Among the more common causes of heart failure are the sequelae of coronary heart disease. The treatment of hypertension modifies the progression to heart failure and the occurrence of coronary events. In patients who have heart failure, hypotension rather than hypertension is a predictor of a poor outcome, likely because low blood pressure is a consequence of damage to the myocardium. The clinical message is that hypertension should be treated aggressively. Where heart failure is a likely outcome, or where hypertension occurs in the presence of heart failure, there is a strong case for using drugs that have been shown to be beneficial in the treatment of both hypertension and heart failure.
Similar content being viewed by others
References and Recommended Reading
The CONSENSUS Trial Study Group: Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group. N Engl J Med 1987, 316:1429–1435.
Hjalmarson A, Waagstein F: New therapeutic strategies in chronic heart failure: challenge of long- term beta-blockade. Eur Heart J 1991, 12(Suppl F):63–69.
The SOLVD investigators: Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 1992, 327:685–691.
Cohn JN, Johnson G, Ziesche S, et al.: A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991, 325:302–310.
Packer M, Poole-Wilson PA, Armstrong PW, et al.: Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure [in process citation]. Circulation 1999, 100:2312–2318.
Packer M, Bristow MR, Cohn JN, et al.: The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996, 334:1349–1355.
CIBIS-II Investigators and Committees: The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 1999, 353:9–13.
MERIT-HF Study Group: Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999, 353:2001–2007.
Packer M, Coats AJ, Fowler MB, et al.: Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001, 344:1651–1658.
Psaty BM, Smith NL, Siscovick DS, et al.: Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and meta-analysis. JAMA 1997, 277:739–745.
Osler W: The principles and practice of medicine. In Anonymous Appleton & Co, 1892:634.
Katz AM: Evolving concepts of heart failure: cooling furnace, malfunctioning pump, enlarging muscle-Part I. J Cardiac Failure 1997, 3:319–334.
Chien KR: Stress pathways and heart failure. Cell 1999, 98:555–558.
Beltrami AP, Urbanek K, Kajstura J, et al.: Evidence that human cardiac myocytes divide after myocardial infarction. N Engl J Med 2001, 344:1750–1757. A recent paper showing that cardiac myocytes from the human heart have the potential to undergo mitosis. This finding undermines a mantra that has been propounded for many years.
Ghali JK, Liao Y, Cooper RS: Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease. J Am Coll Cardiol 1998, 31:1635–1640.
Olivetti G, Abbi R, Quaini F, et al.: Apoptosis in the failing human heart. N Engl J Med 1997, 336:1131–1141.
Narula J, Haider N, Virmani R, et al.: Apoptosis in myocytes in end-stage heart failure [see comments]. N Engl J Med 1996, 335:1182–1189.
Poole-Wilson PA: The dimensions of human cardiac myocytes; confusion caused by methodology and pathology. J Mol Cell Cardiol 1995, 27:863–865.
Cowie MR, Mosterd A, Wood DA, et al.: The epidemiology of heart failure. Eur Heart J 1997, 18:208–225. An excellent review of all the data up to 1997.
Cowie MR, Wood DA, Coats AJ, et al.: Survival of patients with a new diagnosis of heart failure: a population based study. Heart 2000, 83:505–510.
McDonagh T, Morrison CE, Lawrence A, et al.: Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet 1997, 350:829–833.
Schirmer H, Lunde P, Rasmussen K: Prevalence of left ventricular hypertrophy in a general population; The Tromso Study. Eur Heart J 1999, 20:429–438.
The Digitalis Investigation Group: The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997, 336:525–533.
Kannel WB, Ho K, Thom T: Changing epidemiological features of cardiac failure. Br Heart J 1994, 72:S3-S9.
Eriksson H, Svardsudd K, Larsson B, et al.: Risk factors for heart failure in the general population: the study of men born in 1913. Eur Heart J 1989, 10:647–656.
McKee PA, Castelli WP, McNamara PM, Kannel WB: The natural history of congestive heart failure: the Framingham Study. N Engl J Med 1971, 285:1441–1446.
Teerlink JR, Goldhaber SZ, Pfeffer MA: An overview of contemporary aetiologies of congestive heart failure. Am Heart J 1991, 121:1852–1853.
,Cowie MR, Wood DA, Coats AJ et al.: Incidence and aetiology of heart failure; a population-based study. Eur Heart J 1999, 20:421–428.
Fox KF, Cowie MR, Wood DA, et al.: Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J 2001, 22:228–236.
Uretsky BF, Thygesen K, Armstrong PW, et al.: Acute coronary findings at autopsy in heart failure patients with sudden death: results from the assessment of treatment with lisinopril and survival (ATLAS) trial. Circulation 2000, 102:611–616. A paper to humble the physician. Postmortem findings demonstrate that physicians are not able to determine the etiology of heart failure or the cause of death accurately using noninvasive methods.
Heart Outcomes Prevention Evaluation Study Investigators: Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000, 355:253–259.
Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensin-converting- enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153.
Cohn JN, Archibald DG, Ziesche S, et al.: Effect of vasodilator therapy on mortality in chronic congestive heart failure: results of a Veterans Administration Cooperative Study. N Engl J Med 1986, 314:1547–1552.
Packer M, O’Connor CM, Ghali JK, et al.: Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 1996, 335:1107–1114.
Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999, 341:709–717.
Pitt B, Poole-Wilson PA, Segal R, et al.: Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial--the Losartan Heart Failure Survival Study ELITE II. Lancet 2000, 355:1582–1587.
Chin MH, Goldman L: Correlates of major complications or death in patients admitted to the hospital with congestive heart failure. Arch Intern Med 1996, 156:1814–1820.
Johnson G, Carson P, Francis GS, Cohn JN: Influence of prerandomization (baseline) variables on mortality and on the reduction of morality by enalapril: Veterans Affairs Cooperative Study on Vasodilator Therapy of Heart Failure (V-HeFT II). Circulation 1993, 87:VI32-VI39.
Garg R, Yusuf S: Overview of randomized trials of angiotensin- converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials. J Am Med Assoc 1995, 273:1450–1456.
The Beta-Blocker Evaluation of Survival Trial Investigators: A trial of the beta-blocker bucindolol in patients with advanced chronic heart failure. N Engl J Med 2001, 344:1659–1667.
Harris P: Evolution and the cardiac patient. Cardiovasc Res 1983, 17:437–445. Two seminal papers on the fundamental understanding of heart failure. Essential reading for anyone wanting to understand the pathophysiology of the clinical syndrome of heart failure.
Harris P: Evolution and the cardiac patient. Cardiovasc Res 1983, 17:373–378.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Poole-Wilson, P.A. Implications of recent heart failure trials for patients with hypertension. Curr Cardiol Rep 3, 504–510 (2001). https://doi.org/10.1007/s11886-001-0073-2
Issue Date:
DOI: https://doi.org/10.1007/s11886-001-0073-2