Hypertension in Heart Failure With Reduced Ejection Fraction: Cause or Disease Modifier?

The coexistence of hypertension and HFrEF should be distinguished from a causal progression from hypertensive heart disease to systolic heart failure. Available experimental, longitudinal, and clinical evidence does not consistently demonstrate such a transition in the absence of additional non hypertensive myocardial injury. In this context, the intriguing association reported by Harada et al. between changes in serum adiponectin and improvement in left ventricular ejection fraction specifically in patients with HFrEF and hypertension may identify hypertension as a modifier of the metabolic and inflammatory response of the failing myocardium rather than as the primary cause of systolic dysfunction. (see graphical abstract).