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Differential impact of antihypertensive drugs on cardiovascular remodeling: a review of findings and perspectives for HFpEF prevention

Hypertension Research volume 45, pages 53–60 (2022)Cite this article

Abstract

Heart failure (HF) is an important health problem worldwide whose stages have traditionally been classified from A to D. In addition, HF can be categorized as that with preserved ejection fraction (HFpEF) and that with reduced ejection fraction (HFrEF). Hypertension and arterial stiffness in stage A HF are major drivers of the progression to left ventricular hypertrophy (LVH), a criterion of stage B HF. Although the pathogenesis of HFpEF is heterogeneous, affected patients tend to be older than HFrEF patients and have a greater prevalence of hypertension, which is closely associated with arterial stiffness and LVH. Thus, to treat HFpEF, the optimal intervention for improving prognosis is an aggressive approach to early-stage, i.e., Stage A and B, HF. This paper reviews the findings on arterial stiffness and LVH using conventional antihypertensive drugs such as angiotensin receptor II blockers (ARBs) and a new drug class for HF, ARB/neprilysin inhibitor (ARNi). Previous studies have suggested that the combination of an ARB with an L–T-type calcium channel blocker might be recommended for the improvement of arterial stiffness and regression of LVH. More recent research has shown that ARNi also improves central BP, which leads to a reduced afterload and a significant reduction in LVH. For optimal treatment of HFpEF, drug therapy should directly address arterial stiffness as well as hypertension.

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Authors and Affiliations

  1. Department of Internal Medicine, Clinic Jingumae, Nara, Japan

    Takeshi Takami

  2. Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan

    Satoshi Hoshide & Kazuomi Kario

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K Kario reports scholarships from Otsuka Pharmaceuticals, Daiichi Sankyo, Sumitomo Dainippon Pharma, Boehringer Ingelheim Japan and Takeda Pharmaceuticals; honoraria from Sanwa Kagaku, Daiichi Sankyo, Novartis Pharma, Boehringer Ingelheim Japan and Mylan EPD outside the submitted work. The remaining authors declare that they have no conflict of interest.

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Takami, T., Hoshide, S. & Kario, K. Differential impact of antihypertensive drugs on cardiovascular remodeling: a review of findings and perspectives for HFpEF prevention. Hypertens Res 45, 53–60 (2022). https://doi.org/10.1038/s41440-021-00771-6

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