Treating hypertension in patients with left ventricular dysfunction: hitting the fairway and avoiding the rough
Department of Medicine, Division of Cardiovascular Medicine
Antihypertensive Agents; Heart Failure; Humans; Hypertension; Ventricular Dysfunction, Left
Cardiology | Cardiovascular Diseases
Hypertension is a major risk factor in the development of heart failure (HF), yet current guidelines do not specify a target blood pressure (BP) for patients with established systolic or diastolic left ventricular (LV) dysfunction. While no randomized controlled trial (RCT) has been conducted to specify the optimal blood pressure in these patients, numerous trials have demonstrated the benefits of certain classes of medications and treatment strategies in patients with HF. Important factors to consider in treating hypertension in patients with HF include the type of HF (reduced vs. preserved ejection fraction), the etiology (ischemic vs. nonischemic), the severity of symptoms if any, the baseline blood pressure, as well as a wide variety of patient-specific factors. This paper reviews current evidence to address the question, "What should be the blood pressure goal in patients with asymptomatic and symptomatic left ventricular dysfunction?" We suggest a target blood pressure of 120-140/70-90 mm Hg in most cases, with lower pressures generally preferable if tolerated.
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Citation: Joffe SW, Phillips RA. Treating hypertension in patients with left ventricular dysfunction: hitting the fairway and avoiding the rough. Curr Heart Fail Rep. 2013 Jun;10(2):157-64. doi: 10.1007/s11897-013-0137-9. Link to article on publisher's site
Current heart failure reports
Joffe, Samuel W. and Phillips, Robert A., "Treating hypertension in patients with left ventricular dysfunction: hitting the fairway and avoiding the rough" (2013). University of Massachusetts Medical School Faculty Publications. 403.