The Role of Systolic Blood Pressure Reduction in Diastolic Dysfunction: RAAS Inhibition versus Non-RAAS Blood Pressure Lowering

摘要

Hypertension significantly contributes to cardiovascular morbidity and mortality by causing substantial structural and functional adaptations, including left ventricular (LV) diastolic dysfunction (DD).1)2) LVDD is characterized by alterations in LV diastolic filling, which may include impairments in myocardial relaxation and abnormal distensibility of the myocardium. Importantly, LVDD is considered a critical link between hypertension and heart failure (HF), particularly in individuals with HF preserved ejection fraction (HFpEF), which is quite prevalent, accounting for up to one-half of patients with HF, and is associated with substantial morbidity and mortality.3)4) The prevalence of HFpEF has progressively increased over the last decades, but death rates have not changed substantially.5) These trends highlight the importance of understanding the pathophysiologic alterations that precede the development HFpEF, particularly hypertension-induced LVDD.