Impact of diabetes and hypertension on the heart

Abstract

Hypertension and diabetes both contribute to cardiovascular disease. The purpose of this review is to summarize novel epidemiological and clinical insights into the risk continuum of blood pressure and abnormalities in glucose metabolism for cardiovascular adverse remodelling, summarize the current mechanistic knowledge on hypertensive heart disease and diabetic cardiomyopathy, outline the effects of hypertension and diabetes on diastolic dysfunction and heart failure with normal ejection fraction, and discuss novel therapeutic aspects in these disease entities. The prevalence of diabetes mellitus and hypertension increases in western populations and largely contributes to adverse cardiovascular remodelling and the growing number of patients with heart failure. Recently, diastolic heart failure (i.e., heart failure with normal ejection fraction) has been recognized as a major adverse manifestation of hypertension and diabetes, but convincing therapeutic strategies other than strict risk factor control are still lacking. However, due to clearer definitions and novel noninvasive diagnostic techniques for heart failure with normal ejection fraction, future studies may better define new specific therapeutic approaches. New insights into the epidemiology and pathophysiology of diabetes-associated and hypertension-associated cardiac alterations may open the field for novel preventive therapeutic strategies tailored to reduce the risk of heart failure in this large population at risk.