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Hypertension Global Newsletter #3 Hype
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CARDIOVASCULAR DISEASE RISK
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Growing heart failure burden of hypertensive heart disease: A call to action.

Díez J, Butler J. Hypertension. 2022 Sep 9:101161HYPERTENSIONAHA12219373. Online ahead of print.

Hypertensive heart disease (HHD) is the second leading
cause of HF, and despite substantial improvement in arterial
hypertension treatment, the prevalence of HHD and its
associated risk of HF have increased. Prevention of HF in
patients with HHD remains an unmet medical need, and
this conceptual framework is a call to action to improve the
diagnosis and treatment of myocardial interstitial fibrosis
(MIF), the lesion most critically involved in the transition from
subclinical HHD to clinically overt HF.

Along with the assessment of morphological and functional
LV changes, BP control, and LVH regression, the authors
suggest that the detection and reversal of histological changes
that develop in the hypertensive heart and that lead to the
structural remodelling of the myocardium be considered.
Pathophysiological aspects that contribute to MIF are a
result of a sequential and complex processes, moving from
initiating factors, interstitial changes, and resulting in clinical
consequences.

Proposed pathways to treat patients with HHD, including biomarker-guided therapy of MIF

ACC, American College of Cardiology; AHA, American Heart Association; EAPC, European Association of Preventive Cardiology; ESC, European Society of
Cardiology; HFA, Heart Failure Association (of the ESC); HFSA, Heart Failure Society of America; MIF, myocardial interstitial fibrosis; PICP, carboxy-terminal
propeptide of procollagen type I.

The authors propose that the diagnosis of HHD must go beyond a change in LV morphology and function assessed by classical
imaging methods and should include the assessment of MIF-related parameters provided by newer imaging methods, for
example, the extracellular volume assessed by cardiac MRI and immunoassay methods to measure serum carboxy-terminal

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