Arterial hypertension and chronic heart failure

Arterial hypertension, alone or in combination with ischemic heart disease, precedes the development of heart failure. The Framingham study demonstrated that hypertension was the major risk factor in the development of heart failure. Arterial hypertension is not a sole factor contributing to the development of heart failure. The syndrome of heart failure is a consequence of multiple systemic responses and the development of heart failure is a complex and progressive process associated with cardiovascular disease resulting from risk factors: hypertension, obesity, smoking and dyslipidaemia. Arterial hypertension is the main precursor of left ventricular hypertrophy. Initially, this process causes diastolic dysfunction in the early stages of primary hypertension. Systolic dysfunction is rarely observed in those subjects. Left ventricular hypertrophy is also an important risk factor for myocardial infarction and ventricular arrhythmias. Asymptomatic systolic and diastolic left ventricular dysfunction may both progress to overt HFThe primary prevention of heart failure patients should be based upon strategies providing tight and sustained blood pressure control. This therapy should include an agent that inhibits the renin–angiotensin–aldosterone system. Treatment of arterial hypertension in patients with HF must take into account the prevalent type of cardiac dysfunction—diastolic or systolic.