title: Current Perspectives on Systemic Hypertension in Heart Failure with Preserved Ejection Fraction.
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.
authors.affiliation: Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Marty C
authors.initials: MC
authors.lastname: Tam
authors.affiliation: Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Ran
authors.initials: R
authors.lastname: Lee
authors.affiliation: Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Cascino
authors.affiliation: Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Konerman
authors.affiliation: Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA. scothumm@med.umich.edu.|Ann Arbor Veterans Affairs Health System, 1500 E. Medical Center Drive, 2383 CVC/SPC 5853, Ann Arbor, MI, 48109, USA. scothumm@med.umich.edu.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hummel
mesh_terms: D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome
keywords: HTN; Heart failure phenotypes; Heart failure with preserved ejection fraction