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Current Perspectives on Systemic Hypertension in Heart Failure with Preserved Ejection Fraction

  • Hypertension and the Heart (D Kitzman and B Upadhya, Section Editors)
  • Published:
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Abstract

Heart failure with preserved ejection fraction (HFpEF) is a prevalent but incompletely understood syndrome. Traditional models of HFpEF pathophysiology revolve around systemic HTN and other causes of increased left ventricular afterload leading to left ventricular hypertrophy (LVH) and diastolic dysfunction. However, emerging models attribute the development of HFpEF to systemic proinflammatory changes secondary to common comorbidities which include HTN. Alterations in passive ventricular stiffness, ventricular-arterial coupling, peripheral microvascular function, systolic reserve, and chronotropic response occur. As a result, HFpEF is heterogeneous in nature, making it difficult to prescribe uniform therapies to all patients. Nonetheless, treating systemic HTN remains a cornerstone of HFpEF management. Antihypertensive therapies have been linked to LVH regression and improvement in diastolic dysfunction. However, to date, no therapies have definitive mortality benefit in HFpEF. Non-pharmacologic management for HTN, including dietary modification, exercise, and treating sleep disordered breathing, may provide some morbidity benefit in the HFpEF population. Future research is need to identify effective treatments, perhaps in more specific subgroups, and focus may need to shift from reducing mortality to improving exercise capacity and symptoms. Tailoring antihypertensive therapies to specific phenotypes of HFpEF may be an important component of this strategy.

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Acknowledgments

Dr. Hummel is funded by NIH/NHLBI K23-HL109176, NIH/NIA R21-AG047939, AHRQ R21-HS024567, and PurFoods, LLC to perform HTN-associated research.

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Authors and Affiliations

  1. Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA

    Marty C. Tam, Ran Lee, Thomas M. Cascino, Matthew C. Konerman & Scott L. Hummel

  2. Ann Arbor Veterans Affairs Health System, 1500 E. Medical Center Drive, 2383 CVC/SPC 5853, Ann Arbor, MI, 48109, USA

    Scott L. Hummel

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  1. Marty C. Tam
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Correspondence to Scott L. Hummel.

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Dr. Hummel reports grants from PurFoods, LLC. Drs. Tam, Lee, Cascino, and Konerman declare no conflicts of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Hypertension and the Heart

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Tam, M.C., Lee, R., Cascino, T.M. et al. Current Perspectives on Systemic Hypertension in Heart Failure with Preserved Ejection Fraction. Curr Hypertens Rep 19, 12 (2017). https://doi.org/10.1007/s11906-017-0709-2

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