Role of Blood Pressure in the Development of Congestive Heart Failure

TLDR

Early, vigorous and sustained control of elevated blood pressure—both systolic and diastolic—is the chief means for preventing congestive heart failure in the general population. A 16‑year cohort study of 5,192 adults examined how systolic and diastolic pressures related to myocardial hypertrophy and heart failure, finding that systolic pressure correlated more strongly with left‑ventricular thickness and hypertrophy than diastolic pressure, and that other pressure indices offered no additional predictive value. Hypertension preceded CHF in 75 % of cases, and hypertensive individuals were six times more likely to develop CHF than normotensives; systolic pressure alone predicted CHF risk as well as combined pressure measures, and only half of patients survived five years after onset.

Abstract

A representative population sample of 5192 men and women was followed for 16 years, during which overt congestive heart failure (CHF) developed in 142. In the age range from 30 to 62 years the dominant etiologic precursor was hypertension, which preceded CHF in 75 per cent of the cases. Six times more CHF developed in hypertensive than in normotensive persons. Examination of the association of myocardial hypertrophy on x-ray or electrocardiographic study with systolic versus diastolic pressure revealed little to suggest a greater role for diastolic pressure. Systolic and diastolic pressure together, mean arterial pressure, pulse pressure, and tension-time index discriminated potential hypertrophy and CHF no better than systolic pressure alone. Examination of the correlation of heart weight and left ventricular thickness at autopsy with premorbid systolic versus diastolic pressure revealed a better correlation with systolic than with diastolic pressure. CHF was a lethal phenomenon, with only 50 per cent surviving for five years. Early, vigorous and sustained control of elevated blood pressure — systolic as well as diastolic — appears the chief means for preventing CHF in the general population.