Epidemiological Aspects (Prevalence and Risk of Heart Failure Related to Blood Pressure)

  • Peter Wohlfahrt
  • Renata Cífková
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)


Heart failure (HF) is a common, highly morbid, and costly clinical syndrome with a growing impact on global public health. Hypertension is the most prevalent risk factor for HF and carries the highest population attributable risk among all risk factors for HF. Approximately 40% of HF cases in men and 60% in women are attributed to hypertension. Epidemiological aspects of HF differ by HF type. Patients with HF with preserved ejection fraction (HFpEF), as compared to HF with reduced ejection fraction (HFrEF), are older and have hypertension and atrial fibrillation more frequently, while a history of myocardial infarction is less common. Furthermore, the incidence and prevalence of HFpEF increase more steeply with age as compared to HFrEF. The reasons for HF epidemic differ by country income. While in high-income countries it is largely driven by aging of the population, in middle- and low-income countries it is also related to the increase in age-standardized prevalence of hypertension. Absence of hypertension, obesity, and diabetes substantially prolongs HF-free survival and life expectancy. Treatment of hypertension, particularly in individuals aged over 60 years, is associated with the largest reduction of HF compared to other cardiovascular events. This chapter describes in detail the epidemiological aspects and trajectories of the relationship between hypertension and HF.


Definition of heart failure Classification of heart failure Prevalence of heart failure Incidence of heart failure Heart failure with reduced ejection fraction Heart failure with preserved ejection fraction Heart failure with midrange ejection fraction Mortality in heart failure 



Supported by grant No. 15-27109A provided by the Ministry of Health of the Czech Republic.


  1. 1.
    Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129–200.CrossRefGoogle Scholar
  2. 2.
    Silverman MG, Patel B, Blankstein R, et al. Impact of race, ethnicity, and multimodality biomarkers on the incidence of new-onset heart failure with preserved ejection fraction (from the multi-ethnic study of atherosclerosis). Am J Cardiol. 2016;117:1474–81.CrossRefGoogle Scholar
  3. 3.
    Hsu JJ, Ziaeian B, Fonarow GC. Heart failure with mid-range (borderline) ejection fraction: clinical implications and future directions. JACC Heart Fail. 2017;5:763–71.CrossRefGoogle Scholar
  4. 4.
    Bleumink GS, Knetsch AM, Sturkenboom MC, et al. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure The Rotterdam Study. Eur Heart J. 2004;25:1614–9.CrossRefGoogle Scholar
  5. 5.
    Bursi F, Weston SA, Redfield MM, et al. Systolic and diastolic heart failure in the community. JAMA. 2006;296:2209–16.CrossRefGoogle Scholar
  6. 6.
    Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9.CrossRefGoogle Scholar
  7. 7.
    Vasan RS, Xanthakis V, Lyass A, et al. Epidemiology of left ventricular systolic dysfunction and heart failure in the Framingham Study: an echocardiographic study over 3 decades. JACC Cardiovasc Imaging. 2017;11(1):1–11.CrossRefGoogle Scholar
  8. 8.
    Bahrami H, Kronmal R, Bluemke DA, et al. Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis. Arch Intern Med. 2008;168:2138–45.CrossRefGoogle Scholar
  9. 9.
    Roger VL. Epidemiology of heart failure. Circ Res. 2013;113:646–59.CrossRefGoogle Scholar
  10. 10.
    Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6:606–19.CrossRefGoogle Scholar
  11. 11.
    Rowley WR, Bezold C, Arikan Y, et al. Diabetes 2030: insights from yesterday, today, and future trends. Popul Health Manag. 2017;20:6–12.CrossRefGoogle Scholar
  12. 12.
    Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014;371:818–27.CrossRefGoogle Scholar
  13. 13.
    Dokainish H, Teo K, Zhu J, et al. Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. Lancet Glob Health. 2017;5:e665–72.CrossRefGoogle Scholar
  14. 14.
    Callender T, Woodward M, Roth G, et al. Heart failure care in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med. 2014;11:e1001699.CrossRefGoogle Scholar
  15. 15.
    Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–96.CrossRefGoogle Scholar
  16. 16.
    Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–50.CrossRefGoogle Scholar
  17. 17.
    Jhund PS, Macintyre K, Simpson CR, et al. Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5.1 million people. Circulation. 2009;119:515–23.CrossRefGoogle Scholar
  18. 18.
    Yeung DF, Boom NK, Guo H, et al. Trends in the incidence and outcomes of heart failure in Ontario, Canada: 1997 to 2007. CMAJ. 2012;184:E765–73.CrossRefGoogle Scholar
  19. 19.
    Gerber Y, Weston SA, Redfield MM, et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000-2010. JAMA Intern Med. 2015;175:996–1004.CrossRefGoogle Scholar
  20. 20.
    Levy D, Larson MG, Vasan RS, et al. The progression from hypertension to congestive heart failure. JAMA. 1996;275:1557–62.CrossRefGoogle Scholar
  21. 21.
    Butler J, Kalogeropoulos AP, Georgiopoulou VV, et al. Systolic blood pressure and incident heart failure in the elderly. The Cardiovascular Health Study and the health, ageing and body composition study. Heart. 2011;97:1304–11.CrossRefGoogle Scholar
  22. 22.
    Chirinos JA, Segers P, Duprez DA, et al. Late systolic central hypertension as a predictor of incident heart failure: the multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2015;4:e001335.CrossRefGoogle Scholar
  23. 23.
    Wohlfahrt P, Melenovsky V, Redfield MM, et al. Aortic waveform analysis to individualize treatment in heart failure. Circ Heart Fail. 2017;10:e003516.CrossRefGoogle Scholar
  24. 24.
    Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–61.CrossRefGoogle Scholar
  25. 25.
    Ahmad FS, Ning H, Rich JD, et al. Hypertension, obesity, diabetes, and heart failure-free survival: the cardiovascular disease lifetime risk pooling project. JACC Heart Fail. 2016;4:911–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Peter Wohlfahrt
    • 1
  • Renata Cífková
    • 1
    • 2
  1. 1.Center for Cardiovascular PreventionCharles University in Prague, First Faculty of Medicine and Thomayer HospitalPragueCzech Republic
  2. 2.Department of Medicine IICharles University in Prague, First Faculty of MedicinePragueCzech Republic

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