机构:
Univ Oxford, George Inst Global Hlth, Oxford OX1 2JD, England
Univ Oxford, Oxford Martin Sch, Deep Med, Oxford, EnglandUniv Oxford, George Inst Global Hlth, Oxford OX1 2JD, England
Pinho-Gomes, Ana Catarina
[1
,2
]
Rahimi, Kazem
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机构:
Univ Oxford, George Inst Global Hlth, Oxford OX1 2JD, England
Univ Oxford, Oxford Martin Sch, Deep Med, Oxford, EnglandUniv Oxford, George Inst Global Hlth, Oxford OX1 2JD, England
Rahimi, Kazem
[1
,2
]
机构:
[1] Univ Oxford, George Inst Global Hlth, Oxford OX1 2JD, England
[2] Univ Oxford, Oxford Martin Sch, Deep Med, Oxford, England
Hypertension is a common comorbidity in patients with heart failure and most drugs that have demonstrated to improve prognosis in this population have the potential to reduce blood pressure. Nonetheless, the relationship between blood pressure and clinical outcomes and the relevance of blood pressure reduction in heart failure remains unclear. This narrative review summarises the evidence currently available to guide blood pressure treatment in this patient group and highlights key questions for further research. In patients with heart failure with reduced ejection fraction, guidelines consensually recommend treating hypertension with drugs that have compelling indications in heart failure, with a target blood pressure of 130/80 mmHg. In patients with heart failure with preserved ejection fraction, guidelines acknowledge that the optimal treatment strategy remains unclear and thus recommend adopting a similar treatment strategy to patients with reduced ejection fraction. In any case, low blood pressure should not deter uptitration of drugs otherwise indicated to improve prognosis in heart failure, provided that patients tolerate drugs without adverse events. In the absence of evidence for modification of treatment efficacy and safety by baseline blood pressure, it is likely that treatment may actually lead to higher absolute risk reduction in patients with the lowest blood pressure. Special considerations and treatment adjustments are needed in the elderly as well as in patients with diabetes, chronic kidney disease and atrial fibrillation. More evidence is needed on blood pressure management in patients with heart failure in general, in whom the increasing burden of multimorbidity adds further complexity to treatment.
机构:
Juntendo Univ, Grad Sch Med, Dept Cardiovasc Biol & Med, Tokyo, JapanJuntendo Univ, Grad Sch Med, Dept Cardiovasc Biol & Med, Tokyo, Japan
Matsue, Yuya
Teramoto, Kanako
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机构:
Natl Heart Ctr, Singapore, Singapore
Natl Cerebral & Cardiovasc Ctr, Dept Biostat, Osaka, JapanJuntendo Univ, Grad Sch Med, Dept Cardiovasc Biol & Med, Tokyo, Japan
Teramoto, Kanako
Sunayama, Tsutomu
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机构:
Juntendo Univ, Grad Sch Med, Dept Cardiovasc Biol & Med, Tokyo, JapanJuntendo Univ, Grad Sch Med, Dept Cardiovasc Biol & Med, Tokyo, Japan
Sunayama, Tsutomu
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机构:
Tromp, Jasper
Minamino, Tohru
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h-index: 0
机构:
Juntendo Univ, Grad Sch Med, Dept Cardiovasc Biol & Med, Tokyo, Japan
Japan Agcy Med Res & Dev, Japan Agcy Med Res & Dev Core Res Evolutionary Med, Tokyo, JapanJuntendo Univ, Grad Sch Med, Dept Cardiovasc Biol & Med, Tokyo, Japan