Díez Javier, Butler Javed
Center for Applied Medical Research (CIMA), and School of Medicine, Universidad de Navarra, and Center for Network Biomedical Research of Cardiovascular Diseases (CIBERCV), Carlos III Institute of Health, Madrid, Spain (J.D.).
Baylor Scott and White Research Institute, Dallas, TX, and Department of Medicine, University of Mississippi School of Medicine, Jackson (J.B.).
Hypertension. 2023 Jan;80(1):13-21. doi: 10.1161/HYPERTENSIONAHA.122.19373. Epub 2022 Sep 9.
Hypertensive heart disease (HHD) is currently the second leading cause of heart failure. The prevalence of HHD and its associated risk of heart failure have increased despite substantial improvement in arterial hypertension treatment and control in the recent decades. Therefore, the prevention of heart failure in patients with HHD represents an unmet medical need, due to its clinical, economic, and social impact. In this conceptual framework, we call to action because the time has come for diagnosis and treatment of patients with HHD not to be limited to assessment of morphological and functional left ventricular changes, blood pressure control, and left ventricular hypertrophy regression. We propose a further perspective incorporating also the detection and reversal of the histological changes that develop in the hypertensive heart and that lead to the structural remodeling of the myocardium. In particular, we focus on the diagnosis and treatment of myocardial interstitial fibrosis, likely the lesion most critically involved in the transition from subclinical HHD to clinically overt heart failure. In this context, it is worth considering whether the use of imaging and circulating biomarkers for the noninvasive diagnosis of myocardial interstitial fibrosis should be incorporated in the medical study of hypertensive patients, especially of those with HHD.
高血压性心脏病（HHD）目前是心力衰竭的第二大主要病因。尽管近几十年来动脉高血压的治疗和控制有了显著改善，但HHD的患病率及其相关的心力衰竭风险仍在增加。因此，鉴于其临床、经济和社会影响，预防HHD患者发生心力衰竭是一项尚未满足的医疗需求。在这一概念框架下，我们呼吁采取行动，因为现在是时候让HHD患者的诊断和治疗不再局限于评估左心室的形态和功能变化、控制血压以及使左心室肥厚消退。我们提出了一个进一步的观点，即还要纳入对高血压心脏中发生的、导致心肌结构重塑的组织学变化的检测和逆转。特别是，我们关注心肌间质纤维化的诊断和治疗，这可能是从亚临床HHD转变为临床明显心力衰竭过程中最关键的病变。在这种情况下，值得考虑的是，在高血压患者尤其是HHD患者的医学研究中，是否应纳入使用影像学和循环生物标志物对心肌间质纤维化进行无创诊断。
