Skip to main content
SpringerLink
Log in

Myocardial Ischemia: A Link Between Hypertension and Heart Failure

  • Chapter
  • First Online:
Hypertension and Heart Failure

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

  • 112 Accesses

Abstract

Hypertension is one of the major risk factors for morbidity and mortality worldwide, while the most common cause of death in hypertensive patients is heart failure. Myocardial ischemia is an important pathophysiologic link between high blood pressure and heart failure. Hypertension can lead to myocardial ischemia through two main mechanisms: by promoting atherosclerosis of the major coronary arteries and by left ventricular hypertrophy with vascular remodeling and microcirculatory dysfunction. A remodeled left ventricle will determine an impaired systolic and/or diastolic performance; consequently, the patients will develop heart failure with either reduced or preserved ejection fraction. In this chapter, we summarize the main pathways in the pathophysiological continuum of hypertension, myocardial ischemia, and heart failure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Oh GC, Cho HJ. Blood pressure and heart failure. Clin Hypertens. 2020;26:1.

    Article  Google Scholar 

  2. https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed 6 Mar 2022.

  3. Kazzam E, Ghurbana BA, Obineche EN, Nicholls MG. Hypertension—still an important cause of heart failure? J Hum Hypertens. 2005;19(4):267–75.

    Article  CAS  Google Scholar 

  4. Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557–62.

    Article  CAS  Google Scholar 

  5. Messerli FH, Rimoldi SF, Bangalore S. The transition from hypertension to heart failure: contemporary update. JACC Heart Fail. 2017;5:543–51.

    Article  Google Scholar 

  6. Iriarte M, Murga N, Sagastagoitia D, Morillas M, Boveda J, Molinero E, Etxebeste J, Salcedo A, Rodriguez E, Ormaetxe JM. Classification of hypertensive cardiomyopathy. Eur Heart J. 1993;14 Suppl J:95–101.

    CAS  Google Scholar 

  7. Yip GW, Fung JWH, Tan YT, Sanderson JE. Hypertension and heart failure: a dysfunction of systole, diastole or both? J Hum Hypertens. 2009;23:295–306.

    Article  CAS  Google Scholar 

  8. Burkhoff D, Maurer SM, Packer M. Heart failure with a normal ejection fraction, is it really a disorder of diastolic function? Circulation. 2003;107:656–8.

    Article  Google Scholar 

  9. Mottram PM, Haluska BA, Leano R, Carlier S, Case C, Marwick T. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart. 2005;91:1551–6.

    Article  CAS  Google Scholar 

  10. Borlaug BA, Melenovsky V, Russell SD, Kessler K, Pacak K, Becker LC, Kass DA. Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction. Circulation. 2006;114:2138–47.

    Article  Google Scholar 

  11. Drazner MH. The progression of hypertensive heart disease. Circulation. 2011;123:327–34.

    Article  Google Scholar 

  12. Spinar J. Hypertension and ischemic heart disease. Cor Vasa. 2012;54:E433–8.

    Article  Google Scholar 

  13. Dorobantu M, Onciul S, Tautu OF, Cenko E. Hypertension and ischemic heart disease in women. Curr Pharm Des. 2016;22:3885–92.

    Article  CAS  Google Scholar 

  14. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Meterson BJ, Oparil S, Wright JT Jr, Roccella EJ. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.

    Article  CAS  Google Scholar 

  15. Olafiranye O, Zizi F, Brimah P, Jean-louis G, Makaryus AN, McFarlane S, Ogedegbe G. Management of hypertension among patients with coronary heart disease. Int J Hypertens. 2011;2011:653903. https://doi.org/10.4061/2011/653903.

    Article  Google Scholar 

  16. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes JIII. Factors of risk in the development of coronary heart disease—six-year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33–50.

    Article  CAS  Google Scholar 

  17. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, BudajA PP, Varigos J, Lisheng L. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.

    Article  Google Scholar 

  18. Cachofeiro V, Miana M, de las Heras N, Martin-Fernandez B, Ballesteros S, Balfagon G, Lahera V. Inflammation: a link between hypertension and atherosclerosis. Curr Hypertens Rev. 2009;5:40–8.

    Article  CAS  Google Scholar 

  19. Bleakley C, Hamilton PK, Pumb R, Harbinson M, McVeigh GE. Endothelial function in hypertension: victim or culprit? J Clin Hypertens. 2015;17(8):651–4.

    Article  Google Scholar 

  20. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685–95.

    Article  CAS  Google Scholar 

  21. Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868–74.

    Article  CAS  Google Scholar 

  22. Bautista LE, Lopez-Jaramillo P, Vera LM, Casas JP, Otero AP, Guaracao AI. Is C-reactive protein an independent risk factor for essential hypertension? J Hypertens. 2001;19:857–61.

    Article  CAS  Google Scholar 

  23. Bautista LE, Vera LM, Arenas IA, Gamarra G. Independent association between inflammatory markers (C-reactive protein, interleukin 6 and TNF alpha) and essential hypertension. J Hum Hypertens. 2005;19:149–54.

    Article  CAS  Google Scholar 

  24. Peeters ACTM, Netea MG, Janssen MCH, Kullberg BJ, Van der Meer JWM, Thien T. Proinflammatory cytokines in patients with essential hypertension. Eur J Clin Invest. 2001;31:31–6.

    Article  CAS  Google Scholar 

  25. Boos CJ, Lip GYH. Is hypertension an inflammatory process? Curr Pharm Des. 2006;12:1623–35.

    Article  CAS  Google Scholar 

  26. Phillips MI, Kagiyama S. Angiotensin II as a pro-inflammatory mediator. Curr Opin Investig Drugs. 2002;3:569–77.

    CAS  Google Scholar 

  27. Agbor-Etang BB, Setaro JF. Management of hypertension in patients with ischemic heart disease. Curr Cardiol Rep. 2015;17:119.

    Article  Google Scholar 

  28. Rodriguez JA, Orbe J, Paramo JA. Metalloproteases, vascular remodelling, and atherothrombotic syndromes. Rev Esp Cardiol. 2007;60:959–67.

    Article  Google Scholar 

  29. Dirksen MT, van der Wal AC, van den Berg FM, van der Loos CM, Becker AE. Distribution of inflammatory cells in atherosclerotic plaques relates to the direction of flow. Circulation. 1998;98:2000–3.

    Article  CAS  Google Scholar 

  30. Chirinos JA, Segers P. Noninvasive evaluation of left ventricular afterload: part 1: pressure and flow measurements and basic principles of wave conduction and reflection. Hypertension. 2010;56(4):555–62.

    Article  CAS  Google Scholar 

  31. Nadruz W. Myocardial remodeling in hypertension. J Hum Hypertens. 2015;29:1–6.

    Article  CAS  Google Scholar 

  32. du Cailar G, Pasquie JL, Ribstein J, Mimran A. Left ventricular adaptation to hypertension and plasma renin activity. J Hum Hypertens. 2000;14:181–8.

    Article  Google Scholar 

  33. Stanton T, Dunn FG. Hypertension, left ventricular hypertrophy and myocardial ischemia. Med Clin North Am. 2017;101(1):29–41.

    Article  Google Scholar 

  34. Chobanian AV. Vascular effects of systemic hypertension. Am J Cardiol. 1992;69:3E–7E.

    Article  CAS  Google Scholar 

  35. Camici PG, Olivotto I, Rimoldi OE. The coronary circulation and blood flow in left ventricular hypertrophy. J Mol Cell Cardiol. 2012;52(4):857–64.

    Article  CAS  Google Scholar 

  36. Bassenge E, Heusch G. Endothelial and neuro-humoral control of coronary blood flow in health and disease. Rev Physiol Biochem Pharmacol. 1990;116:77–165.

    Article  CAS  Google Scholar 

  37. Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev. 2008;88(3):1009–86.

    Article  CAS  Google Scholar 

  38. Hamasaki S, Al Suwaidi J, Higano ST, Miyauchi K, Holmes DR Jr, Lerman A. Attenuated coronary flow reserve and vascular remodeling in patients with hypertension and left ventricular hypertrophy. J Am Coll Cardiol. 2000;35:1654–60.

    Article  CAS  Google Scholar 

  39. Feihl F, Liaudet L, Levy BI, Waeber B. Hypertension and microvascular remodelling. Cardiovasc Res. 2008;78:274–85.

    Article  CAS  Google Scholar 

  40. Tang EH, Vanhoutte PM. Endothelial dysfunction: a strategic target in the treatment of hypertension? Pflugers Arch. 2010;459:995–1004.

    Article  CAS  Google Scholar 

  41. Taddei S, Virdis A, Ghiadoni L, Sudano I, Salvetti A. Endothelial dysfunction in hypertension. J Cardiovasc Pharmacol. 2001;38:S11–4.

    Article  CAS  Google Scholar 

  42. Rethy L, McCabe M, Pool LR, Vu THT, Kershaw KN, Yancy C, Vupputuri S, Feinglass J, Khan SS. Contemporary rates of hospitalization for heart failure in young and middle-aged adults in a diverse US state. Circ Cardiovasc Qual Outcomes. 2020;13(11):e007014.

    Article  Google Scholar 

  43. Braunwald E. Heart failure. JACC Heart Fail. 2013;1:1–20.

    Article  Google Scholar 

  44. Lloyd-Jones DM, Larson MG, Ep L, Beiser A, D’Agostino RB, Kannel WB, Murabito JM, Vasan RS, Benjamin EJ, Levy D. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106(24):3068–72.

    Article  Google Scholar 

  45. Elgendy IY, Mahtta D, Pepine CJ. Medical therapy for heart failure caused by ischemic heart disease. Circ Res. 2019;124(11):1520–35.

    Article  CAS  Google Scholar 

  46. Gheorghiade M, Sopko G, De Luca L, Velasquez EJ, Parker JD, Binkley PF, Sadowski Z, Golba KS, Prior DL, Rouleau JL, Bonow RO. Navigating the crossroads of coronary artery disease and heart failure. Circulation. 2006;114:1202–13.

    Article  Google Scholar 

  47. Kenchaiah S, Pfeffer MA, Sutton MSJ, Plappert T, Rouleau JL, Lamas GA, Sasson Z, Parker JO, Geltman EM, Solomon SD. Effect of antecedent systemic hypertension on subsequent left ventricular dilation after acute myocardial infarction (from the survival and ventricular enlargement trial). Am J Cardiol. 2004;94(1):1–8.

    Article  Google Scholar 

  48. Richards AM, Nicholls MG, Troughton RW, Lainchbury JG, Elliott J, Framptom C, Espiner EA, Crozier IG, Yandle TG, Turner J. Antecedente hypertension and heart failure after myocardial infarction. J Am Coll Cardiol. 2002;39(7):1182–8.

    Article  Google Scholar 

  49. Albakri A. Ischemic heart failure: a review of clinical status and meta-analysis of diagnosis and clinical management methods. Clin Med Invest. 2018;3(4):1–15.

    Google Scholar 

  50. Libby P, Theroux P. Pathophysiology of coronary artery disease. Circulation. 2005;111(25):3481–8.

    Article  Google Scholar 

  51. Sutton MG, Sharpe N. Left ventricular remodelling after myocardial infarction: pathophysiology and therapy. Circulation. 2000;101:2981–8.

    Article  CAS  Google Scholar 

  52. Pagliaro BR, Cannata F, Stefanini GG, Bolognese L. Myocardial ischemia and coronary disease in heart failure. Heart Fail Rev. 2020;25(1):53–65.

    Article  Google Scholar 

  53. Jenca D, Melenovsky V, Stehlik J, Stanek V, Kettner J, Kautzner J, Adamkova V, Wohlfahrt P. Heart failure after myocardial infarction: incidence and predictors. ESC Heart Fail. 2021;8(1):222–37.

    Article  Google Scholar 

  54. Niccoli G, Burzotta F, Galiuto L, Crea F. Myocardial no-reflow in humans. J Am Coll Cardiol. 2009;54:281–92.

    Article  Google Scholar 

  55. Shah RV, Rong J, Larson MG, Yeri A, Ziegler O, Tanriverdi K, Murthy V, Liu X, Xiao C, Pico AR, Huan T, Levy D, Lewis GD, Rosenzweig A, Vasan RS, Das S, Freedman JE. Associations of circulating extracellular RNAs with myocardial remodelling and heart failure. JAMA Cardiol. 2018;3:871–6.

    Article  Google Scholar 

  56. Carvalho LSF, Bogniotti LAC, de Almeida OLR, e Silva JC, Nadruz W, Coelho OR, Sposito AC. Change of BNP between admission and discharge after ST-elevation myocardial infarction (Killip I) improves risk prediction of heart failure, death, and recurrent myocardial infarction compared to single isolated measurement in addition to the GRACE score. Eur Heart J Acute Cardiovasc Care. 2019;8:643–51.

    Article  Google Scholar 

  57. Asleh R, Enriquez-Sarano M, Jaffe AS, Manemann SM, Weston SA, Jiang R, Roger VL. Galectin-3 levels and outcomes after myocardial infarction: a population-based study. J Am Coll Cardiol. 2019;73:2286–95.

    Article  CAS  Google Scholar 

  58. Jenkins WS, Roger VL, Jaffe AS, Weston SA, Abou Ezzeddine OF, Jiang R, Manemann SM, Enriquez-Sarano M. Prognostic value of soluble ST2 after myocardial infarction: a community perspective. Am J Med. 2017;130:1112.e9–e15.

    Article  CAS  Google Scholar 

  59. Sulo G, Igland J, Vollset SE, Nygard O, Ebbing M, Sulo E, Egeland GM, Tell GS. Heart failure complicating acute myocardial infarction; burden and timing of occurrence: a nation-wide analysis including 86771 patients from the cardiovascular disease in Norway (CVDNOR) project. J Am Heart Assoc. 2016;5:e002667.

    Article  Google Scholar 

  60. Santoro GM, Carrabba N, Migliorini A, Parodi G, Valenti R. Acute heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Eur J Heart Fail. 2008;10:780–5.

    Article  Google Scholar 

  61. Sorajja P, Gersh BJ, Cox DA, McLaughlin MG, Zimetbaum P, Costantini C, Stuckey T, Tcheng JE, Mehran R, Lansky AJ, Grines CL, Stone GW. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J. 2007;28:1709–16.

    Article  Google Scholar 

  62. Melchior T, Rask-Madsen C, Torp-Pedersen C, Hildebrandt P, Kober L, Jensen G. The impact of heart failure on prognosis of diabetic and non-diabetic patients with myocardial infarction: a 15-year follow-up study. Eur J Heart Fail. 2001;3:83–90.

    Article  CAS  Google Scholar 

  63. Wellings J, Kostis JB, Sargsyan D, Cabrera J, Kostis WJ. Risk factors and trends in incidence of heart failure following acute myocardial infarction. Am J Cardiol. 2018;122:1–5.

    Article  Google Scholar 

  64. Wang J, Khoury DS, Yue Y, Torre-Amione G, Nagueh SH. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Eur Heart J. 2008;29:1283–9.

    Article  CAS  Google Scholar 

  65. Sanderson JE. Heart failure with a normal ejection fraction. Heart. 2007;93:155–8.

    Article  CAS  Google Scholar 

  66. Redfield MM. Heart failure with preserved ejection fraction. N Engl J Med. 2016;375:1868–77.

    Article  Google Scholar 

  67. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: part II: causal mechanisms and treatment. Circulation. 2002;105:1503–8.

    Article  Google Scholar 

  68. Vanhecke TE, Kim R, Raheem SZ, McCullough PA. Myocardial ischemia in patients with diastolic dysfunction and heart failure. Curr Cardiol Rep. 2010;12:216–22.

    Article  Google Scholar 

  69. Ishii K, Suyama T, Imai M, Maenaka M, Yamanaka A, Makino Y, Seino Y, Shimada K, Yoshikawa J. Abnormal regional left ventricular systolic and diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention: clinical significance of post-ischemic diastolic stunning. J Am Coll Cardiol. 2009;54(17):1589–97.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Maria Dorobantu & Aura Vîjîiac

  2. Emergency Clinical Hospital of Bucharest, Bucharest, Romania

    Aura Vîjîiac

Authors
  1. Maria Dorobantu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aura Vîjîiac
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Carol Davila University of Medicine and Pharmacy, Bucharest, Bucuresti, Romania

    Maria Dorobantu

  2. Department of Pharmacology, Toxicology and Clinical Psychopharmacology Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Victor Voicu

  3. University of Milano-Bicocca, Milano, Italy

    Guido Grassi

  4. Dept of Clinical and Experimental Sci, University of Brescia, Brescia, Italy

    Enrico Agabiti-Rosei

  5. University of Milano-Bicocca, Milano, Italy

    Giuseppe Mancia

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dorobantu, M., Vîjîiac, A. (2023). Myocardial Ischemia: A Link Between Hypertension and Heart Failure. In: Dorobantu, M., Voicu, V., Grassi, G., Agabiti-Rosei, E., Mancia, G. (eds) Hypertension and Heart Failure. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-031-39315-0_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-39315-0_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-39314-3

  • Online ISBN: 978-3-031-39315-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation