Leone Dario, Vallelonga Fabrizio, Botta Matteo, Cesareo Marco, Airale Lorenzo, Colomba Anna, Fragapani Salvatore, Bruno Giulia, Mingrone Giulia, Ligato Jacopo, Sanapo Martina, Veglio Franco, Milan Alberto
Division of Internal Medicine, Candiolo Cancer Institutute FPO - IRCCS, Candiolo.
Department of Medical Sciences, University of Turin.
J Hypertens. 2025 Apr 1;43(4):606-614. doi: 10.1097/HJH.0000000000003942. Epub 2024 Dec 10.
Heart failure with preserved ejection fraction (HFpEF) is a high prevalence condition, with high rates of hospitalization and mortality. Arterial hypertension is the main risk factor for HFpEF. Among hypertensive patients, alterations in cardiac and vascular morphology identify hypertension-mediated organ damage (HMOD). Cardiac HMOD in terms of ventricular hypertrophy and diastolic dysfunction is a continuum between the preclinical condition (arterial hypertension) and HFpEF. In hypertensive patients, it is currently unknown what is the prevalence of individuals classifiable as being at high risk of developing HFpEF and whether aortic morphofunctional vascular changes are present.
This study seeks to retrospectively assess the prevalence of echocardiographic alterations consistent with the diagnosis of HFpEF in a cohort of patients with essential arterial hypertension, and the prevalence of vascular HMOD (V-HMOD) in different risk categories of patients.
Hypertensive outpatients referred at the Hypertension Center of Turin from 2003 to 2021 were retrospectively evaluated. Patients with a previous diagnosis of heart failure and known cardiovascular events were excluded. A predictive model associated with the risk of HFpEF development was calculated using echocardiographic variables. V-HMOD morphological and functional parameters were assessed by ascending aorta diameter and arterial stiffness (carotid-femoral pulse wave velocity, cfPWV).
Eight hundred and four patients (34.8% women) were analyzed, age 53.1 ± 14 years; left ventricular mass index (LVMi) and E / e' ratio were impaired in 15.9 and 29.1% of cases, respectively. Dividing them into tertiles according to score: score 1 or less (30.2%); score 2-3 (47.4%); score at least 3 (22.7%). Patients identified at high risk of HFpEF (score ≥3) had higher age, BMI and blood pressure than the other two groups ( P < 0.05); they showed a significantly higher prevalence of female patients (42.3%), treatment with at least two antihypertensive drugs (40.1%), diabetes (7.1%), and dyslipidemia (28%; P < 0.05), with a larger ascending aorta diameter (35.5 ± 5.5 mm, P < 0.05) and higher cfPWV (8.8 ± 2.4 m/s, P < 0.05).
At least one in five hypertensive patients, referred to an outpatient echocardiographic examination, has C-HMOD compatible with a high-risk category of HFpEF and have a significant increase in V-HMOD. This reinforces the notion that arterial hypertension and HFpEF are not two distinctly separate conditions but a continuum of pathophysiologic alterations.
射血分数保留的心力衰竭（HFpEF）是一种高患病率的疾病，住院率和死亡率都很高。动脉高血压是HFpEF的主要危险因素。在高血压患者中，心脏和血管形态的改变可识别高血压介导的器官损害（HMOD）。从临床前状态（动脉高血压）到HFpEF，以心室肥厚和舒张功能障碍为表现的心脏HMOD是一个连续过程。目前尚不清楚高血压患者中可归类为有发生HFpEF高风险的个体的患病率，以及是否存在主动脉形态功能血管改变。
本研究旨在回顾性评估一组原发性动脉高血压患者中与HFpEF诊断一致的超声心动图改变的患病率，以及不同风险类别患者中血管HMOD（V-HMOD）的患病率。
对2003年至2021年在都灵高血压中心就诊的高血压门诊患者进行回顾性评估。排除既往有心力衰竭诊断和已知心血管事件的患者。使用超声心动图变量计算与HFpEF发生风险相关的预测模型。通过升主动脉直径和动脉僵硬度（颈股脉搏波速度，cfPWV）评估V-HMOD的形态和功能参数。
共分析了804例患者（34.8%为女性），年龄53.1±14岁；左心室质量指数（LVMi）和E/e'比值受损的病例分别占15.9%和29.1%。根据评分将他们分为三分位数：评分1或更低（30.2%）；评分2 - 3（47.4%）；评分至少3（22.7%）。被确定为有HFpEF高风险（评分≥3）的患者比其他两组年龄更大、BMI和血压更高（P<0.05）；他们女性患者的患病率显著更高（42.3%），使用至少两种抗高血压药物治疗的比例更高（40.1%），糖尿病患病率更高（7.1%），血脂异常患病率更高（28%；P<0.05），升主动脉直径更大（35.5±5.5mm，P<0.05），cfPWV更高（8.8±2.4m/s，P<0.05）。
在接受门诊超声心动图检查的高血压患者中，至少五分之一的患者存在与HFpEF高风险类别相符的心脏HMOD，且V-HMOD显著增加。这强化了动脉高血压和HFpEF不是两种截然不同的疾病，而是病理生理改变的连续过程这一观点。
