Heart Failure Reviews

, Volume 23, Issue 5, pp 631–639 | Cite as

The role of arterial hypertension in development heart failure with preserved ejection fraction: just a risk factor or something more?

  • Marijana TadicEmail author
  • Cesare Cuspidi
  • Athanasios Frydas
  • Guido Grassi


Heart failure with preserved ejection fraction (HFpEF) is an entity that still raises many questions. The agreement about definition, pathophysiology, and therapeutic approach is still missing. Arterial hypertension is present in majority of patients with HFpEF, and it is still not clear if it represent a risk factor or “sine qua non” condition for HFpEF development. The underlying mechanisms of hypertension and HFpEF involve the same biohumoral systems: renin-angiotensin-aldosterone, sympathetic nervous system, and oxidative stress. However, not all hypertensive patients have HFpEF. The predisposition of some hypertensive patients to develop HFpEF needs to be resolved. Large randomized controlled trials did not prove the usefulness of renin–angiotensin–aldosterone inhibitors, diuretics, calcium channel blockers, and beta-blockers in HFpEF patients. The majority of studies did not succeed to demonstrate the reduction of cardiovascular and all-cause mortality in HFpEF individuals. One of the major limitations in these investigations was the inconsistency of HFpEF definition, which mainly refers to left ventricular ejection fraction (LVEF) cut-off that ranged from 40 to 50% in different studies. This review article provides the available data about pathophysiology and mechanisms that connect hypertension and HFpEF, investigations and therapy used in both conditions.


Arterial hypertension Heart failure with preserved ejection fraction Pathophysiology Therapy 


Compliance with ethical standards

Conflict of interest



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Authors and Affiliations

  1. 1.Department of Internal Medicine and CardiologyCharité – Universitätsmedizin BerlinBerlinGermany
  2. 2.Istituto Auxologico Italiano, Clinical Research UnitUniversity of Milan-BicoccaMedaItaly
  3. 3.Department of Health ScienceUniversity of Milano-BicoccaMilanItaly
  4. 4.IRCCS MultimedicaMilanItaly

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