Contemporary Strategies to Manage High Blood Pressure in Patients with Coexistent Resistant Hypertension and Heart Failu
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REVIEW
Contemporary Strategies to Manage High Blood Pressure in Patients with Coexistent Resistant Hypertension and Heart Failure With Reduced Ejection Fraction Katherine Lang . Erik H. Van Iterson
. Luke J. Laffin
Received: October 12, 2020 Ó The Author(s) 2020
ABSTRACT Resistant hypertension (RH) represents an advanced subtype of hypertension that is complex to diagnose and treat. Compared with general hypertension, RH increases the risk patients will develop more advanced cardiovascular complications, including heart failure with reduced ejection fraction (HFrEF). As expected, the prevalence of RH has increased since the introduction of lower blood pressure targets included in the recent 2017 American blood pressure guidelines. The array of pharmacotherapies available to treat both hypertension and HFrEF has also expanded within the
K. Lang Case Western Reserve University School of Medicine, Cleveland, OH, USA E. H. Van Iterson (&) L. J. Laffin Section of Preventive Cardiology and Rehabilitation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA e-mail: [email protected]
past decade. However, the efficacy of these cutting-edge pharmacotherapies has not come without a more advanced understanding of the important adjunct role non-pharmacological therapies play in helping with the management of both hypertension and HFrEF. In this review, we provide a summary of the latest pharmacological and non-pharmacological strategies that can be used to initiate treatment and optimize long-term blood pressure control in patients with coexistent RH and HFrEF.
Keywords: Heart failure; Heart failure with reduced ejection fraction; Hypertension; Resistant hypertension
Cardiol Ther
Key Summary Points Resistant hypertension (RH) represents an advanced subtype of hypertension that is complex to diagnose, treat, and increases the risk patients develop advanced cardiovascular complications, such as heart failure with reduced ejection fraction (HFrEF). As the number of patients with RH continues to rise in the United States, so too does the prevalence of patients with HFrEF and also those with coexistent RH and HFrEF. There is no randomized controlled clinical trial-based evidence available to guide the use of pharmacotherapies for the optimal management of BP specifically in patients with coexistent RH and HFrEF. In this review, we summarize the latest pharmacological and nonpharmacological interventions that are available for potentially optimizing BP control in patients with coexistent RH and HFrEF. Non-pharmacological therapies, including exercise training, when individually prescribed based on the model established in HFrEF is medically reasonable and can be expected to contribute to the effective management of both resting and ambulatory BP in patients with coexistent RH and HFrEF. Cutting-edge treatment options, including small interfering RNAs, renal denervation, and baroreflex activation therapy, are currently under investigation. As higherquality data become available from random
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