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The Role of Drug Therapy in Lowering Mortality and Morbidity: From High-Risk Hypertension to Established 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 evaluation of the existing evidence for the different treatment principles in heart failure with preserved ejection fraction (HFpEF), constituting more than half of all patients with heart failure with the phenotype characterized by hypertension, atrial fibrillation, coronary heart disease, and diabetes, conclusions for current treatment recommendations have been drawn on variable grounds and that the lack of significant results in HFpEF trials in greater part relies on technical weaknesses of the conducted trials, than on a true effect of the medications not being present. With few prospects of future attempts to recover these errors, we suggest a compromise to limit the potential damage accompanying them and have accordingly described how the treatment principles for hypertensive heart failure consist of renin-angiotensin-system (RAS) inhibition or angiotensin receptor-neprilysin inhibition (ARNi), beta-blocker, and mineralocorticoid receptor antagonist, and, if necessary, application of diuretics for fluid control. Furthermore, SGLT2 inhibitors are proven to prevent hospitalization and death throughout the entire EF spectrum. In conclusion, common treatment principles should apply to all patients with heart failure—regardless of ejection fraction. In the future, elevated natriuretic peptides such as NT-pro-BNP will be a needed criterion for diagnosing heart failure.

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Abbreviations

ACEi:

Angiotensin-converting enzyme inhibitor

ARB:

Angiotensin receptor blocker

ARNi:

Angiotensin receptor-neprilysin inhibitor

CCB:

Calcium channel blocker

MRA:

Mineralocorticoid receptor antagonist

SGLT2i:

Sodium-glucose co-transporter 2 inhibitor

CHARM:

Candesartan in heart failure assessment of reduction in mortality and morbidity

CONSENSUS:

Cooperative north Scandinavian enalapril survival study

EMPHESUS:

Eplerenone in patients with heart failure due to systolic dysfunction complicating acute myocardial infarction

EPHESUS:

Eplerenone post-AMI heart failure efficacy and survival study

I-PRESERVE:

Irbesartan in heart failure with preserved ejection fraction

RALES:

Randomized aldactone evaluation study

SAVE:

Survival and ventricular enlargement

SENIORS:

Study of the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure

SOLVD:

Studies of left ventricular dysfunction

TOPCAT:

Treatment of preserved cardiac function heart failure with an aldosterone antagonist

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Author information

Authors and Affiliations

  1. University of Oslo, Faculty of Medicine, Institute for Clinical Medicine, Oslo, Norway

    Aurora Rist, Kaja Sevre & Sverre E. Kjeldsen

  2. Department of Cardiology, University of Oslo Hospital, Ullevaal, Oslo, Norway

    Nisha Mistry, Sverre E. Kjeldsen & Arne S. Westheim

Authors
  1. Aurora Rist
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  2. Kaja Sevre
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  3. Nisha Mistry
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  4. Sverre E. Kjeldsen
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  5. Arne S. Westheim
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Corresponding author

Correspondence to Sverre E. Kjeldsen .

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

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Rist, A., Sevre, K., Mistry, N., Kjeldsen, S.E., Westheim, A.S. (2023). The Role of Drug Therapy in Lowering Mortality and Morbidity: From High-Risk Hypertension to Established 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_25

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  • DOI: https://doi.org/10.1007/978-3-031-39315-0_25

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  • Online ISBN: 978-3-031-39315-0

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