Emory Clinical Cardiovascular Research Institute, Emory University, Atlanta, GA 30322, USA.
Drugs. 2012 Jul 9;72(10):1373-98. doi: 10.2165/11631100-000000000-00000.
The heart failure epidemic calls for urgent prevention efforts. Hypertension is present in the majority of individuals who develop heart failure and carries the highest population-attributable risk for heart failure together with coronary heart disease. Therefore, hypertension is a natural prime target for prevention interventions. However, a substantial proportion of heart failure develops among individuals with a systolic BP (SBP) level below current therapeutic target recommendations (140 mmHg or 130 mmHg for high-risk groups), which are accepted as 'normal' levels, underlining the importance of prehypertension for heart failure development. Prevalence and incidence of both hypertension and prehypertension are high. Efforts to prevent or attenuate BP rise could lead to a substantial reduction of complications, including heart failure development. Lifestyle modifications play a crucial role in preventing elevation of BP levels and better control of high BP. Weight loss, control of sodium intake and diet, and physical activity are essential steps towards this direction. However, when medications are needed to reduce BP levels, the selection of the appropriate agent is important not only for effective control of BP but also to reduce hypertension-related complications. Diuretics and renin-angiotensin system modulators seem to be the most effective agents for heart failure prevention according to the existing evidence. Patients with heart failure and hypertension should be treated for hypertension based on the same principles, although medication selection should take into account concomitant medications, other risk factors and type of heart failure (reduced vs preserved left ventricular ejection fraction).
心力衰竭流行呼吁紧急预防措施。高血压存在于大多数发展为心力衰竭的个体中，与冠心病一起，对心力衰竭具有最高的人群归因风险。因此，高血压是预防干预的自然主要目标。然而，相当一部分心力衰竭发生在收缩压（SBP）水平低于当前治疗目标建议（高危人群为 140mmHg 或 130mmHg）的个体中，这些水平被接受为“正常”水平，强调了高血压前期对心力衰竭发展的重要性。高血压和高血压前期的患病率和发病率都很高。预防或减轻血压升高的努力可能会导致并发症的大量减少，包括心力衰竭的发展。生活方式的改变在预防血压升高和更好地控制高血压方面起着至关重要的作用。减轻体重、控制钠摄入量和饮食以及体育活动是朝着这个方向迈出的重要步骤。然而，当需要药物来降低血压水平时，选择合适的药物不仅对于有效控制血压很重要，而且对于减少与高血压相关的并发症也很重要。根据现有证据，利尿剂和肾素-血管紧张素系统调节剂似乎是预防心力衰竭最有效的药物。心力衰竭和高血压患者应根据相同的原则治疗高血压，尽管药物选择应考虑伴随的药物、其他风险因素和心力衰竭类型（左心室射血分数降低与保留）。
