Dilemmas of Blood Pressure Management for Heart Failure Prevention

Abstract

More than 5.5 million individuals in the United States have heart failure (HF), more than a half-million individuals are diagnosed annually, and more than 1 million HF hospitalizations occur yearly.1 Outcomes remain poor, with approximately 50% of patients dying within 5 years of diagnosis.2 These trends will worsen when aging of the 78 million baby boomers will result in 1 in 5 Americans to be over the age of 65 years by the year 2050.3 HF incidence and prevalence are highest in the elderly. Incidence rate is 10 per 1000 individuals after age 65 years, and 80% of patients hospitalized with HF are over 65 years of age.1 A recent statement from the American Heart Association suggests that if the current trend continues, then by 2030 HF prevalence will increase by 25%, as opposed to 16.6% and 9.9% increase in coronary heart disease and hypertension, respectively, leading to a rise in estimated direct and indirect cost of care to 95 billion dollars annually.4 These trends underscore the importance of population-based strategies to prevent HF. Patient 1 was a 66-year-old woman with a body mass index of 24, who was examined at a routine annual visit to her primary care physician. Her blood pressure was 148/94 mm Hg after 5 minutes in sitting position. She did not have diabetes mellitus or history of cardiovascular (CV) disease, and she did not smoke. Her routine laboratory tests were unremarkable, including normal renal function. She was asymptomatic. Patient 2 was a 74-year-old man with a body mass index of 32, who was examined at a routine clinic visit to his cardiologist. His blood pressure was 148/94 mm Hg after 5 minutes in sitting position. He did not have diabetes mellitus. He had a history of non–Q-wave myocardial infarction 3 …