An expert opinion on heart failure in hypertensive heart disease

There is strong evidence that hypertension is a major risk factor for heart failure (HF). Hypertension contributes to incident HF through direct and indirect effects. Indirect effects are consequences of ischaemic heart disease because hypertension facilitates atherosclerotic obstructive coronary artery disease. The direct effects are straightly related to hypertensive heart disease (HHD). Hypertensive heart disease poses a significant challenge with substantial medical and public health implications. Efforts should be made to recognize and manage HHD in a timely manner and optimize hypertension treatment. Reducing blood pressure (BP) and/or reassessing antihypertensive therapy using traditional or novel approaches can halt or delay progression to HF in patients with HHD and possibly prevent it. However, HHD's importance as a risk factor for overt HF is often overlooked in clinical practice. This document aims to summarize the current understanding of the burden of HHD and its risk for incident HF, discuss the mechanisms underlying HHD-related HF onset and progression, consider how diagnostic tools contribute to individualized phenotyping and HF risk stratification of HHD, address how therapeutic measures ameliorating or even preventing structural and functional alterations of HHD, along with BP control influence HHD-associated HF risk.