The Framingham study demonstrated that myocardial infarction (25% of cases) and arterial hypertension (AH) (75% of cases) caused the development of chronic heart failure (CHF). The most significant predictor of CHF development was an increase in systolic blood pressure (SBP) and pulse pressure and each increase in SBP by 20 mm Hg and pulse blood pressure by 16 mm Hg led to an increase in the incidence of CHF by 52% and 55%, respectively. The presented clinical case of a patient with CHF, developed due to long-term hypertension, considered the mechanisms of CHF development, as well as the issue of pharmacotherapy of AH in combination with chronic heart failure with systolic dysfunction. The key mechanisms that directly lead to the development of CHF in AH are hemodynamic overload, reduction of myocardial contractility, left ventricular hypertrophy (LVH). The likelihood of CHF development in patients with AH is by 4 times higher, whilst in patients with LVH it is by 15 times higher. Along with LVH, one of the early manifestations of LV remodeling in AH is the development of diastolic dysfunction, which precedes the development of systolic abnormalities in AH and LVH. Antihypertensive therapy resulted in reduction of the incidence of CHF by approximately 52% compared to patients who did not receive adequate therapy. The decrease in the incidence of CHF was linearly dependent on the decrease in SBP: each decrease of SBP by 10 mm Hg led to a 26% reduction in the relative risk in CHF development. It has been established that AH is not only one of the leading etiological factors in CHF development, but also have similar key links in pathogenesis. The strategy for the selection of pathogenetic pharmacotherapy should be determined taking into account the above circumstance. Currently, the European Society of Cardiology recommends prescribing beta-blockers to all patients with stable CHF Class II–IV as a standard treatment in combination with ACE inhibitors and diuretics in the absence of contraindications. In addition to RAAS blockers, medications for patients with AH in combination with systolic CHF can be supplemented with thiazide or loop diuretics, as well as mineralocorticoid receptor ant agonists (MRA).

heart failure; arterial hypertension; systolic dysfunction; beta-blockers; ACE inhibitors

Жарінов О.Й. Переносимість та ефективність метопрололу та бісопрололу у хворих з хронічною серцевою недостатністю залежно від віку / О.Й. Жарінов, О.Є. Кітура // Кардіологу-практику. – 2006. – № 1 (4). – С. 6–16.

Ждан В.М. Аспекти терапії пацієнтів із серцевою недостатністю в поєднанні із фібриляцією передсердь в загальнолікарській практиці / В.М. Ждан, О.Є. Кітура, Є.М. Кітура, М.Ю. Бабаніна // Здобутки клінічної й експериментальної медициною. – 2016. – № 2 (26). – С. 53–56.

Ждан В.М. Клінічні аспекти патогенетичної терапії хронічної серцевої недостатності в загальнолікарській практиці / В.М. Ждан, О.Є. Кітура, Є.М. Кітура, М.Ю. Бабаніна // Медичні перспективи. – 2013. – № 2. – С. 44–46.

Рекомендації Асоціації кардіологів України з діагностики та лікування хронічної серцевої недостатності (2017). Серцева недостатність та коморбідні стани. 2018. – С. 6–66.

Buiciuc O, Rusinaru D, Levy F, Peltier M, Slama M, Leborgne L, Tribouilloy C. Low systolic blood pressure at admission predicts long-term mortality in heart failure with preserved ejection fraction. J Card Fail. 2011 Nov;17 (11):907-15.

Drazner MH. The progression of hypertensive heart disease. Circulation. 2011 Jan 25;123 (3):327-34.

Guder G, Frantz S, Bauersachs J, Allolio B, Wanner C, Roller MT, Ertl G, Angermann CE, Stórk S. Reverse epidemiology in systolic and nonsystolic heart failure: cumulative prognostic benefit of classical cardiovascular risk factors. Circ Heart Fail. 2009;2 (6):563-71.

Haider AW, Larson MG, Franklin SS, Levy D; Framingtiam Heart Study Systolic blood pressure, diastolic blood pressure, and pulse pressure as predictors of risk for congestive heart failure in the Framingham Heart Study. Ann Intern Med. 2003 Jan 7;138 (1 ):10-6.

Janardhanan R, Kramer CM. Imaging in hypertensive heart disease. Expert Rev Cardiovasc Ther. 2011 Feb;9 (2):199-209.

Kapoor JR, Heidenreich PA. Obesity and survival in patients with heart failure and preserved systolic function: a U-shaped relationship. Am Heart J. 2010 Jan;159 (l):75-80.

Maisch B, Alter P, Pankuweit S. Diabetic cardiomyopathy – fact or fiction? Herz. 2011 Mar;36 (2):102-15.

Regitz-Zagrosek V, Seeland U. Sex and gender differences in myocardial hypertrophy and heart failure. Wien Med Wochenschr. 2011 Mar;161 (5-6):109-16.

Roger VL, Weston SA, Redfield MM, Hellermann-Homan JP, Killian J, Yawn BP et al. Trends in heart failure incidence and survival in a community-based population. JAMA 2004;292:344-50

Vasan RS, Levy D. The Role of Hypertension in the Pathogenesis of Heart Failure: A Clinical Mechanistic Overview. Arch Intern Med, 1996;156:1789-96.

Yip GW, Fung JW, Tan YT, Sanderson JE. Hypertension and heart failure: a dysfunction of systole, diastole or both? J Hum Hypertens. 2009 May;23 (5):295-306.