Hypertensive Heart Disease and HFpEF: What We Have Learned in the Last Decade.

Hypertension is the most prevalent risk factor for heart failure (HF) and a primary driver of HF with preserved ejection fraction (HFpEF). Chronic pressure overload in hypertensive heart disease leads to left ventricular hypertrophy, myocardial fibrosis, and diastolic dysfunction, which eventually cause elevated filling pressures and HF symptoms despite preserved systolic function. Over the past decade, HFpEF has increasingly been recognized as a multi-system syndrome influenced by systemic inflammation, comorbidities, and metabolic factors. In hypertensive HFpEF, myocardial remodeling is further promoted by neurohormonal activation, endothelial dysfunction, and cardiometabolic stress. Blood pressure control also influences prognosis. Observational studies suggest a reverse J-curve relationship, and uncontrolled blood pressure is associated with adverse outcomes. Hypertensive HFpEF reflects the interaction of chronic pressure overload and cardiometabolic inflammation and requires integrated management that targets blood pressure, comorbidities, and myocardial remodeling.