We all know that hypertension has little effect as long as the blood pressure level is controlled. However, if blood pressure is not actively controlled, or if it is combined with other diseases, the chances of danger are greatly increased.
For example, the risk of heart failure in hypertensive patients is six times higher than in the general population, with an incidence of 28.9%.
So what can be done to avoid such a situation? Once it happens, how should it be treated? Take a look together.
1.Does high blood pressure cause heart failure?
Heart failure is the end stage of most cardiovascular diseases. Patients with hypertension have higher blood pressure for a long time, which aggravates atherosclerotic changes, increases vascular resistance, increases heart load, causes compensatory changes such as ventricular hypertrophy and changes in the shape and size of the ventricles, causing ventricular remodeling, which is the basic pathological basis for the occurrence and development of heart failure.
Heart failure
In addition, the long duration of hypertension is also an independent risk factor for the occurrence of heart failure in patients. Some analysis suggests that hypertensive patients with progressive disease have increasingly weaker metabolism, and residual lipofuscin in cardiomyocytes contributes to myocardial atrophy and gradually weakens myocardial contractile function, which can also increase the risk of heart failure.
2. Do people with hypertension have a higher risk of heart failure?
Yes! Beware.
Some studies have shown that the risk of heart failure is 6 times higher in people with high blood pressure than in the general population, with an incidence of 28.9%.
In recent years, the incidence of hypertension combined with heart failure has been increasing due to changing social and environmental factors, the aging trend of the population, and changes in lifestyle behaviors.
In addition, heart failure patients are also often combined with hypertension, the incidence is about 54.6%.
3, to avoid the occurrence of heart failure, hypertension patients with blood pressure control at what is better?
The results of large clinical trials have shown that antihypertensive treatment can reduce the incidence of heart failure in patients with hypertension, as well as reduce cardiovascular events in patients with heart failure, reduce the rate of death and improve the prognosis.
Antihypertensive targets
Hypertensive patients who have had heart failure or who still have signs and symptoms of heart failure should have their hypertension actively controlled. The target level of blood pressure reduction is <130/80 mmHg.
For patients with persistent hypertension, or hypertension with left ventricular hypertrophy, or with left ventricular dysfunction but without signs and symptoms of heart failure, the treatment goal is also <30/80 mmHg.
By controlling blood pressure in a reasonable range, it is beneficial to prevent the signs and symptoms of heart failure, so it is important to do a good job of prevention in life.
4.What is the treatment when hypertension is combined with heart failure?
Hypertension combined with heart failure, there are two main conditions, namely, combined with chronic heart failure and acute heart failure.
Among them, chronic heart failure includes heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), which need to be treated accordingly according to different situations.
(1) Hypertension combined with chronic HFrEF (heart failure with reduced ejection fraction)
The combination of angiotensin-converting enzyme inhibitors (ACEI), beta-blockers and aldosterone receptor antagonists is the first recommended treatment option for heart failure with reduced ejection fraction (HFrEF), which can reduce mortality and improve the prognosis of patients, and all have good antihypertensive effects.
Most patients with this type of heart failure need to routinely apply tab diuretics (furosemide) or thiazide diuretics (hydrochlorothiazide), which also have good antihypertensive effects.
(2) Hypertension combined with HFpEF (heart failure with preserved ejection fraction)
The above three drugs do not reduce mortality and improve the prognosis of such patients, but they are still recommended for antihypertensive treatment.
If hypertension is still not controlled, amlodipine, felodipine and calcium channel blockers (CCB) with negative inotropic effects, such as diltiazem and verapamil, are recommended.
(3) Hypertension combined with acute heart failure
The main diuretics and vasodilators, including nitroglycerin, sodium nitroprusside or uradil, should be given intravenously to lower blood pressure while controlling heart failure.
If the condition is mild, the blood pressure can be gradually lowered within 24-48 hours.
However, in patients with severe disease and acute pulmonary edema, the reduction of mean arterial pressure should not exceed 25% of the pre-treatment level within the first 1 hour, to 160/100~110mmHg within 2~6 hours, and gradually reduce blood pressure to normal within 24~48 hours.
5. Clinical benefit of antihypertensive treatment
A meta-analysis of large samples showed that for every 10 mmHg reduction in systolic blood pressure (SBP), the risk of heart failure was significantly reduced by 28%. Recent studies have confirmed that intensive blood pressure lowering (SBP <120 mmHg) can significantly reduce the incidence of heart failure by 38% and cardiovascular death by 43% in hypertensive patients compared to standard antihypertensive therapy (SBP <140 mmHg).
References
[1] Yin YG, Lv L, Wang WN. Correlation analysis of serum neuromodulin-1 and ventricular remodeling in patients with essential hypertension combined with heart failure[J]. Chinese Journal of Modern Medicine,2022,32(02):58-63.
[2]Zhang Ying. The first step in controlling blood pressure to prevent heart failure[N]. Health News,2021,12(02).
[3] Chen Junxia, Chen Hong, Xiao Scared M. Intervention of sakubatril valsartan combined with recombinant human cerebrolytic natriuretic peptide in patients with hypertension and heart failure[J]. Cardiovascular disease control knowledge,2021,11(27):10-12.
[4] Zhang Hongling, ed. Clinical diagnosis and treatment practice of hypertension [M]. Kunming:Yunnan Science and Technology Press,2018(03):178-180.