From hypertension to heart failure

Hypertension is a risk factor for the development of heart failure (HF) although the two disease processes have previously been considered clinically and mechanistically distinct. It is now clear that both are progressive cardiovascular structural processes that act in cardiac and vascular remodelling as contributors to morbid events. Blood pressure lowering can no longer be the sole goal of therapy for hypertension and improved myocardial contractility can no longer be the focus of therapy for HF. In both diseases a slowing of the progressive structural abnormality should be the therapeutic target. Furthermore, similar drug therapies (angiotension-converting enzyme inhibitors, beta-blockers, diuretics, angiotensin receptor blockers, calcium antagonists) are used in both conditions and have shown variable effectiveness in slowing the structural processes in the heart and vasculature. Newer methods of evaluating structural alterations in the arteries and heart should facilitate the development and utilization of better targeted therapy. (C) The European Society of Cardiology.