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Development of heart failure in recent hypertension trials

Tocci, Giulianoa; Sciarretta, Sebastianoa; Volpe, Massimoa,b

doi: 10.1097/HJH.0b013e3282fe1d3d
Original papers: Heart

Background Heart failure represents a major cause of disease burden worldwide and is expected to further rise in the coming decades. Hypertension is the clinical condition most frequently associated to heart failure.

Objective To systematically review the incidence of heart failure compared to coronary heart diseases and stroke in recent hypertension trials.

Methods We identified 23 trials concluded within the last decade including 193 424 patients with hypertension or at ‘high’ cardiovascular risk with a predominant presence of hypertensive patients, and reported incidence of major cardiovascular events, including heart failure, coronary heart disease and stroke.

Results A total of 24 837 major cardiovascular events were recorded in trials performed between 1997 and 2007, of which 7171 (28.9%) were cases of heart failure, 10 223 (41.1%) of coronary heart disease and 7443 (30.0%) of stroke. The rate of heart failure was comparable with that of stroke, accounting for 8.5 and 9.1 events per 1000 patients (P = NS), respectively. Heart failure development was more prevalent in older subjects (>65 years) [odds ratio: 3.08, confidence interval 95% (2.88–3.31); P < 0.0001], in black versus nonblack individuals [odds ratio 1.90, (1.76–2.06); P < 0.0001], in diabetic versus nondiabetic patients [odds ratio 4.91, 95% confidence interval (4.40–5.43); P < 0.0001] and in patients with ‘very high’ risk versus those with a ‘high’ risk profile [odds ratio 1.29, 95% confidence interval (1.23–1.36); P < 0.0001].

Conclusion Our analysis shows that heart failure development remains a major problem in hypertension. In recent trials on hypertension, the development of heart failure was found comparable with that of stroke: it is more prevalent in older, black, diabetic and ‘very high’ risk individuals. These findings highlight the relevance of heart failure development in hypertension and support the need for optimizing antihypertensive strategies aimed at preventing the progression to overt heart failure, thus reducing the growing burden of disease associated with hypertension.

aDivision of Cardiology, II Faculty of Medicine, University of Rome ‘La Sapienza’, Sant'Andrea Hospital, Italy

bIRCCS Neuromed, Pozzilli (Isernia), Rome, Italy

Received 19 October, 2007

Revised 20 February, 2008

Accepted 21 February, 2008

Correspondence to Massimo Volpe, MD, FAHA, FESC, Chair and Division of Cardiology, II Faculty of Medicine, University of Rome ‘La Sapienza’, Sant'Andrea Hospital, Via di Grottarossa, 1035-39, 00189 Rome, Italy Tel: +39 06 3377 5654; fax: +39 06 3377 5061; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.