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Nemtsova V, Burkard T, Vischer AS. Hypertensive Heart Disease: A Narrative Review Series-Part 2: Macrostructural and Functional Abnormalities. J Clin Med 2023; 12:5723. [PMID: 37685790 PMCID: PMC10488346 DOI: 10.3390/jcm12175723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Hypertensive heart disease (HHD) remains a major global public health concern despite the implementation of new approaches for the management of hypertensive patients. The pathological changes occurring during HHD are complex and involve the development of structural and functional cardiac abnormalities. HHD describes a broad spectrum ranging from uncontrolled hypertension and asymptomatic left ventricular hypertrophy (LVH), either a concentric or an eccentric pattern, to the final development of clinical heart failure. Pressure-overload-induced LVH is recognised as the most important predictor of heart failure and sudden death and is associated with an increased risk of cardiac arrhythmias. Cardiac arrhythmias are considered to be one of the most important comorbidities affecting hypertensive patients. This is the second part of a three-part set of review articles. Here, we focus on the macrostructural and functional abnormalities associated with chronic high pressure, their involvement in HHD pathophysiology, and their role in the progression and prognosis of HHD.
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Affiliation(s)
- Valeriya Nemtsova
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Internal Diseases and Family Medicine Department, Educational and Scientific Medical Institute, National Technical University “Kharkiv Polytechnic Institute”, 61002 Kharkiv, Ukraine
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
| | - Annina S. Vischer
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland
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Nemtsova V, Vischer AS, Burkard T. Hypertensive Heart Disease: A Narrative Review Series-Part 1: Pathophysiology and Microstructural Changes. J Clin Med 2023; 12:jcm12072606. [PMID: 37048689 PMCID: PMC10094934 DOI: 10.3390/jcm12072606] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Sustained hypertension causes structural, functional, and neurohumoral abnormalities in the heart, a disease commonly termed hypertensive heart disease (HHD). Modern concepts of HHD, including processes of remodeling leading to the development of various LVH patterns, HF patterns accompanied by micro- and macrovasculopathies, and heart rhythm and conduction disturbances, are missing in the available definitions, despite copious studies being devoted to the roles of myocardial and vascular fibrosis, and neurohumoral and sympathetic regulation, in HHD development and progression. No comprehensive and generally accepted universal definition and classification of HHD is available to date, implementing diagnostic criteria that incorporate all the possible changes and adaptions to the heart. The aim of this review series is to summarize the relevant literature and data, leading to a proposal of a definition and classification of HHD. This first article reviews the processes of initial myocardial remodeling, and myocardial and vascular fibrosis, occurring in HHD. We discuss important pathophysiological and microstructural changes, the different patterns of fibrosis, and the biomarkers and imaging used to detect fibrosis in HHD. Furthermore, we review the possible methods of targeting myocardial fibrosis in HHD, and highlight areas for further research.
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Affiliation(s)
- Valeriya Nemtsova
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Internal Diseases and Family Medicine Department, Educational and Scientific Medical Institute, National Technical University "Kharkiv Polytechnic Institute", 61002 Kharkiv, Ukraine
| | - Annina S Vischer
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, 4031 Basel, Switzerland
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland
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Yan T, Zhu S, Yin X, Xie C, Xue J, Zhu M, Weng F, Zhu S, Xiang B, Zhou X, Liu G, Ming Y, Zhu K, Wang C, Guo C. Burden, Trends, and Inequalities of Heart Failure Globally, 1990 to 2019: A Secondary Analysis Based on the Global Burden of Disease 2019 Study. J Am Heart Assoc 2023; 12:e027852. [PMID: 36892088 PMCID: PMC10111559 DOI: 10.1161/jaha.122.027852] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/01/2023] [Indexed: 03/10/2023]
Abstract
Background Heart failure is a public health issue worldwide. However, no comprehensive study on the global burden of heart failure and its contributing causes has been reported. The present study aimed to quantify the burden, trends, and inequalities of heart failure globally. Methods and Results Heart failure data were extracted from the Global Burden of Diseases 2019 study. The number of cases, age-standardized prevalence, and years lived with disability in different locations from 1990 to 2019 were presented and compared. Joinpoint regression analysis was performed to assess trends in heart failure from 1990 to 2019. In 2019, the global age-standardized prevalence and years lived with disability rates for heart failure were 711.90 (95% uncertainty interval [UI], 591.15-858.29) and 63.92 (95% UI, 41.49-91.95) per 100 000 population, respectively. In general, the age-standardized rate decreased globally at an average annual percentage change of 0.3% (95% UI, 0.2-0.3). However, the rate increased at an average annual percentage change of 0.6% (95% UI, 0.4-0.8) from 2017 to 2019. Several nations and territories demonstrated an increased trend from 1990 to 2019, especially in less-developed countries. Ischemic heart disease and hypertensive heart disease accounted for the highest proportion of heart failure in 2019. Conclusions Heart failure remains a major health problem, with increased trends possible in the future. Efforts for prevention and control of heart failure should focus more on less-developed regions. It is essential to prevent and treat primary diseases such as ischemic heart disease and hypertensive heart disease for the control of heart failure.
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Affiliation(s)
- Tao Yan
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Shijie Zhu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Xiujie Yin
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Changming Xie
- Department of CardiologyThe Eighth Affiliated Hospital, Sun Yat‐sen UniversityShenzhenGuangdongChina
| | - Junqiang Xue
- Department of CardiologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Miao Zhu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Fan Weng
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Shichao Zhu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Bitao Xiang
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Xiaonan Zhou
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Gang Liu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yang Ming
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Kai Zhu
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Chunsheng Wang
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Changfa Guo
- Department of Cardiovascular SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina
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Miao H, Zou C, Yang S, Chia Y, Van Huynh M, Sogunuru GP, Tay JC, Wang T, Kario K, Zhang Y. Targets and management of hypertension in heart failure: focusing on the stages of heart failure. J Clin Hypertens (Greenwich) 2022; 24:1218-1225. [PMID: 36196463 PMCID: PMC9532909 DOI: 10.1111/jch.14553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/09/2022] [Indexed: 11/05/2022]
Abstract
Hypertension is highly prevalent worldwide and is the major risk factor for heart failure (HF). More than half of the patients with HF in Asia suffer from hypertension. According to the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guideline, there are four stages of HF, including at risk for HF (stage A), pre-HF (stage B), symptomatic HF (stage C), and advanced HF (stage D). Given the high prevalence of hypertension as well as HF and the stronger association between hypertension and cardiovascular diseases in Asians compared to the west, measures to prevent and alleviate the progression to clinical HF, especially controlling the blood pressure (BP), are of priority for Asian populations. After reviewing evidence-based studies, we propose a BP target of less than 130/80 mmHg for patients at stages A, B, and C. However, relatively higher BP may represent an opportunity to maximize guideline-directed medical therapy (GDMT), which could potentially result in a better prognosis for patients at stage D. Traditional antihypertensive drugs are the cornerstones for the management of hypertension at stages A and B. Notably, calcium channel blockers (CCBs) are inferior to other drug classes for the preventing of HF, whereas diuretics are superior to others. For patients at stage C, GDMT is essential which also helps the control of BP. In particular, sodium-glucose cotransporter-2 (SGLT2) inhibitors are newer therapies recommended for the treatment of HF and presumably even in hypertension to prevent HF. Regarding patients at stage D, GDMT is also recommended if tolerable and measures should be taken to improve hemodynamics.
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Affiliation(s)
- Huanhuan Miao
- Department of CardiologyFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Changhong Zou
- Department of CardiologyFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Shijie Yang
- Department of CardiologyFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Medical and Life SciencesSunway UniversityBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Minh Van Huynh
- Department of Internal MedicineUniversity of Medicine and PharmacyHue UniversityVietnam
| | - Guru Prasad Sogunuru
- Advanced Heart Failure & Device Therapies, MEDWAY HEART INSTITUTEChennaiTamil NaduIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingaporeSingapore
| | - Tzung‐Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital MedicineDepartment of Internal MedicineNational Taiwan University HospitalTaipei CityTaiwan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Yuqing Zhang
- Department of CardiologyFuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
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Rismiati H, Lee HY. Hypertensive Heart Failure in Asia. Pulse (Basel) 2022; 9:47-56. [PMID: 35083170 DOI: 10.1159/000518661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022] Open
Abstract
Hypertension (HT) is an important risk factor for heart failure (HF). The prevalence of HT among the HF population is higher in Asia than in other regions around the world. In Asia, HT is the most common cause of HF after ischemic heart disease. Hypertensive HF (HHF) results from structural and functional adaptations of the heart, which lead to left ventricular (LV) hypertrophy (LVH). Hypertensive LVH can cause ventricular diastolic dysfunction and becomes a risk factor for myocardial infarction, which is a well-known cause of LV systolic dysfunction. Asymptomatic systolic and diastolic LV dysfunction easily progress to clinically overt HF with other precipitating factors. Although the precise pathophysiology of HHF is still unclear, we have known that HHF can be reversed by effective control of blood pressure (BP). Thus, HT control is essential not only for primary prevention but also for the secondary prevention of HF. Here, we reviewed the epidemiology, pathophysiology, outcome, and implication of BP management in HHF patients, especially in the Asian population.
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Affiliation(s)
- Helsi Rismiati
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Cai A, Zhu Y, Clarkson SA, Feng Y. The Use of Machine Learning for the Care of Hypertension and Heart Failure. JACC. ASIA 2021; 1:162-172. [PMID: 36338169 PMCID: PMC9627876 DOI: 10.1016/j.jacasi.2021.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 06/12/2023]
Abstract
Machine learning (ML) is a branch of artificial intelligence that combines computer science, statistics, and decision theory to learn complex patterns from voluminous data. In the last decade, accumulating evidence has shown the utility of ML for prediction, diagnosis, and classification of hypertension and heart failure (HF). In addition, ML-enabled image analysis has potential value in assessing cardiac structure and function in an accurate, scalable, and efficient way. Considering the high burden of hypertension and HF in China and worldwide, ML may help address these challenges from different aspects. Indeed, prior studies have shown that ML can enhance each stage of patient care, from research and development, to daily clinical practice and population health. Through reviewing the published literature, the aims of the current systemic review are to summarize the utilities of ML for the care of those with hypertension and HF.
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Key Words
- ANN, artificial neural network
- AUC, area under the curve
- CNN, convolutional neural network
- HFpEF, heart failure with preserved ejection fraction
- LRM, linear or logistic regression model
- LVDD, left ventricular diastolic dysfunction
- LVH, left ventricular hypertrophy
- ML, machine learning
- RF, random forest
- SVM, support vector machine
- algorithms
- heart failure
- hypertension machine learning
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yicheng Zhu
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Stephen A. Clarkson
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yingqing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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