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Reversibility of Cardiac Remodeling in Hypertensive Patients with Heart Failure

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Hypertension and Heart Failure

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

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Abstract

In hypertensive patients, a fivefold to sixfold higher risk of developing heart failure (HF) than healthy subjects has been reported. The lifetime heart failure risk grows directly proportional to blood pressure. Most hypertensive patients with HF have cardiac and vascular structural and/or functional alterations, even before the onset of clinical symptoms.

ACE inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and sacubitril-valsartan (ARNI) have a beneficial effect on clinical outcome in patients with HF and reduced left ventricular (LV) ejection fraction. The clinical improvement has been attributed to reverse myocardial remodeling, as shown by reduction in LV dimensions and improvement of ejection fraction. More recent trials have documented that in HF patients with reduced ejection fraction, treatment with sodium-glucose co-transporter-2 inhibitors (SGLT2i) significantly improved an improvement in LV ejection fraction and induced a reduction of LV mass index and left atrial volume index. In patients with HF and preserved ejection fraction, no significant changes were observed during treatment with angiotensin receptor blockers or mineralocorticoid receptor antagonists, while favorable changes in cardiac structure induced by ARNI or SGLT2i were suggested.

Further trials are required to determine the effects of treatment on cardiac reverse remodeling in patients with HF and preserved ejection fraction. Whether changes in cardiac remodeling may be associated with improvement in outcome remains an unanswered question.

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Authors and Affiliations

  1. Department of Clinical and Experimental Sciences-University of Brescia, Brescia, Italy

    Anna Paini, Claudia Agabiti Rosei, Carolina De Ciuceis & Massimo Salvetti

  2. Department of Medicine ASST Spedali Civili 25121, Brescia, Italy

    Anna Paini, Claudia Agabiti Rosei, Carolina De Ciuceis & Massimo Salvetti

  3. Department of Clinical and Experimental Sciences-University of Brescia, Internal Medicine ASST Spedali Civili, Brescia, Italy

    Maria Lorenza Muiesan

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  1. Anna Paini
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  3. Carolina De Ciuceis
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  4. Massimo Salvetti
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Correspondence to Maria Lorenza Muiesan .

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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

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Paini, A., Rosei, C.A., De Ciuceis, C., Salvetti, M., Muiesan, M.L. (2023). Reversibility of Cardiac Remodeling in Hypertensive Patients with 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_22

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