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(Circulation. 2008;118:2223.)
© 2008 American Heart Association, Inc.

Editorial

Hypertension, Heart Failure, and Ejection Fraction

From the Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to William C. Little, MD, Cardiology Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157–1045. E-mail wlittle@wfubmc.edu

Key Words: Editorial • heart failure • hypertension • ejection fraction

An extract of the first 250 words of the full text is provided, because this article has no abstract.

More than three quarters of patients with heart failure (HF) have antecedent hypertension.¹ Hypertension appears to play an especially important role in HF associated with a preserved ejection fraction (EF) >0.50 (HFPEF). No proven specific therapy exists for HFPEF, but treatment of systolic hypertension in the elderly (the group at greatest risk for developing HFPEF) reduces the risk of developing HF by about one half.^2,3 The current issue of Circulation contains an important analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) on the effect of the initial drug used to treat hypertension on the subsequent risk of HF requiring hospitalization stratified by EF.⁴

Article p 2259

ALLHAT studied >42 000 hypertensive patients over 55 years of age with at least 1 other coronary artery disease risk factor.⁵ The patients were randomized to receive the initial treatment of their hypertension with a calcium channel blocker (amlodipine), an angiotensin-converting enzyme (ACE) inhibitor (lisinopril), an -adrenergic blocker (doxazosin), or a thiazide diuretic (chlorthalidone). As expected, many of the patients (40% at 5 years) required the addition of other medications to control their hypertension.

Davis et al⁴ identified in the ALLHAT patients 1367 hospitalizations classified as being for HF on the basis of a review of the hospital records. Two thirds of these patients had a determination of their EF. This study includes 3 key findings. First, nearly one half of the patients had HFPEF. As expected, these were frequently older women. Second, the patients with HFPEF had a . . . [Full Text of this Article]