Heart failure does not always occur in advanced hypertensive coronary artery disease. 1. In hypertensive patients with poorly controlled blood pressure over a long period of time, the cardiac afterload is maintained at a high level for a long period of time, thus significantly increasing the risk of heart failure. However, in patients with well-controlled blood pressure, cardiac afterload is not significantly elevated, the risk of heart failure is low, and cardiac function can be maintained at normal levels over time. 2. In patients with coronary artery disease, repeated episodes of myocardial ischemia can cause irreversible damage to the myocardium and lead to heart failure if secondary prevention is not performed properly. However, for those with better secondary prevention (e.g., improvement of arterial stenosis, lipid-lowering to stabilize plaque, aggressive antiplatelet, etc.), the risk of myocardial ischemic events can be significantly reduced, and the risk of heart failure is also smaller. The progression of hypertension and coronary artery disease to heart failure is influenced by a variety of factors, and the risk of progression to heart failure varies depending on the patient’s specific condition. If you feel unwell, you should seek medical attention promptly to avoid delays.