TY - JOUR
T1 - Hypertension and heart failure with preserved ejection fraction
T2 - position paper by the European Society of Hypertension
AU - Kasiakogias, Alexandros
AU - Rosei, Enrico Agabiti
AU - Camafort, Miguel
AU - Ehret, Georg
AU - Faconti, Luca
AU - Ferreira, João Pedro
AU - Brguljan, Jana
AU - Januszewicz, Andrzej
AU - Kahan, Thomas
AU - Manolis, Athanasios
AU - Tsioufis, Konstantinos
AU - Weber, Thomas
AU - von Lueder, Thomas G.
AU - Smiseth, Otto A.
AU - Wachtell, Kristian
AU - Kjeldsen, Sverre E.
AU - Zannad, Faiez
AU - Mancia, Giuseppe
AU - Kreutz, Reinhold
N1 - Funding Information:
K.T. has received travel expenses or Research Grant or honoraria fees from the following: Medtronic, St. Jude Medical, Bayer, Novartis, Astra-Zeneca, Boehringer In, Pfizer, Chiesi, Pharmanel, Sanofi, Vianex, Win-Medica, ELPEN, Recordati, Servier.
Funding Information:
A.M. has received honoraria for lectures in symposia and educational activities sponsored by unrestricted grants from Amgen, Berlin-Chemie, Ferrer, Menarini, Sanofi-Aventis and Servier.
Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Hypertension constitutes a major risk factor for heart failure with preserved ejection fraction (HFpEF). HFpEF is a prevalent clinical syndrome with increased cardiovascular morbidity and mortality. Specific guideline-directed medical therapy (GDMT) for HFpEF is not established due to lack of positive outcome data from randomized controlled trials (RCTs) and limitations of available studies. Although available evidence is limited, control of blood pressure (BP) is widely regarded as central to the prevention and clinical care in HFpEF. Thus, in current guidelines including the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines, blockade of the renin-angiotensin system (RAS) with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers provides the backbone of BP-lowering therapy in hypertensive patients. Although superiority of RAS blockers has not been clearly shown in dedicated RCTs designed for HFpEF, we propose that this core drug treatment strategy is also applicable for hypertensive patients with HFpEF with the addition of some modifications. The latter apply to the use of spironolactone apart from the treatment of resistant hypertension and the use of the angiotensin receptor neprilysin inhibitor. In addition, novel agents such as sodium-glucose co-transporter-2 inhibitors, currently already indicated for high-risk patients with diabetes to reduce heart failure hospitalizations, and finerenone represent promising therapies and results from ongoing RCTs are eagerly awaited. The development of an effective and practical classification of HFpEF phenotypes and GDMT through dedicated high-quality RCTs are major unmet needs in hypertension research and calls for action.
AB - Hypertension constitutes a major risk factor for heart failure with preserved ejection fraction (HFpEF). HFpEF is a prevalent clinical syndrome with increased cardiovascular morbidity and mortality. Specific guideline-directed medical therapy (GDMT) for HFpEF is not established due to lack of positive outcome data from randomized controlled trials (RCTs) and limitations of available studies. Although available evidence is limited, control of blood pressure (BP) is widely regarded as central to the prevention and clinical care in HFpEF. Thus, in current guidelines including the 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines, blockade of the renin-angiotensin system (RAS) with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers provides the backbone of BP-lowering therapy in hypertensive patients. Although superiority of RAS blockers has not been clearly shown in dedicated RCTs designed for HFpEF, we propose that this core drug treatment strategy is also applicable for hypertensive patients with HFpEF with the addition of some modifications. The latter apply to the use of spironolactone apart from the treatment of resistant hypertension and the use of the angiotensin receptor neprilysin inhibitor. In addition, novel agents such as sodium-glucose co-transporter-2 inhibitors, currently already indicated for high-risk patients with diabetes to reduce heart failure hospitalizations, and finerenone represent promising therapies and results from ongoing RCTs are eagerly awaited. The development of an effective and practical classification of HFpEF phenotypes and GDMT through dedicated high-quality RCTs are major unmet needs in hypertension research and calls for action.
UR - http://www.scopus.com/inward/record.url?scp=85111788395&partnerID=8YFLogxK
U2 - 10.1097/HJH.0000000000002910
DO - 10.1097/HJH.0000000000002910
M3 - Article
C2 - 34102660
AN - SCOPUS:85111788395
SN - 1473-5598
VL - 39
SP - 1522
EP - 1545
JO - Journal of hypertension
JF - Journal of hypertension
IS - 8
ER -