Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hypertens. May 23, 2015; 5(2): 85-92
Published online May 23, 2015. doi: 10.5494/wjh.v5.i2.85
From hypertension to heart failure
Klara Magyar, Roland Gal, Adam Riba, Tamas Habon, Robert Halmosi, Kalman Toth
Klara Magyar, Roland Gal, Adam Riba, Tamas Habon, Robert Halmosi, Kalman Toth, 1st Department of Medicine, University of Pecs, Medical School, 7624 Pecs, Hungary
Author contributions: Magyar K, Gal R and Riba A wrote the manuscript and generated figures; Halmosi R, Habon T and Toth K contributed to the writing of the manuscript and assured a professional surveillance.
Conflict-of-interest: All authors disclose any actual or potential conflict of interest including any financial, commercial, personal, political, intellectual, or religious interests or other relationships with other people or organizations which are related to the work submitted for consideration of publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Kalman Toth, MD, ScD, FESC, Professor, 1st Department of Medicine, University of Pecs, Medical School, H-7624 Ifjusag Str. 13., 7624 Pecs, Hungary.
Telephone: +36-72-536000
Received: September 27, 2014
Peer-review started: September 28, 2014
First decision: December 17, 2014
Revised: January 8, 2015
Accepted: January 30, 2015
Article in press: February 2, 2015
Published online: May 23, 2015

Hypertension is an increasing health problem worldwide especially among the elderly. Its therapeutical importance is indicated by the caused organ damages like hypertensive heart disease (HHD) and heart failure with the subsequent higher morbidity and mortality in the population. In HHD ventricular hypertrophy develops as a compensatory mechanism for pressure overload but as the left ventricular compliance decreases, the process can transform into heart failure with firstly preserved and then into reduced ejection fraction (HFpEF, HFrEF). The main characteristics of underlying mechanisms involve cardiomyocyte growth, vessel changes, increased collagen production in all of which several mechanical stress induced neurohumoral agents, signal transduction pathways are involved. According to the new ESC and AHA guidelines five main groups of antihypertensive agents can be applied for decreasing blood pressure and for the prevention of organ damages. Occasionally, patients are not able to tolerate antihypertensive medication because of side effects, drug intolerance or interactions thus it is more difficult to reach the target blood pressure values. Therefore there are several efforts to complete the existing therapeutical possibilities against the development of organ damages like inhibition of Rho/ROCK pathway (e.g., statins), regulation of ROS formation, influence on mitochondrial biogenesis and enhancing recombinant adenovirus hepatocyte growth factor gene. Hypertension induced oxidative stress causes DNA breaks producing the activation of nuclear poly(ADP-ribose) polymerase-1 (PARP) enzyme that leads to energy depletion and unfavorable modulation of different kinase cascades. PARP activation promotes the development of HHD, and its transition to heart failure. Therefore inhibition of PARP-enzyme offers another new therapeutical approach among hypertensive patients. The purpose of this review is to give a comprehensive summary about the most significant mechanisms in HHD and an insight into new potential therapies.

Keywords: Hypertension, Hypertensive heart disease, HfpEF, Organ damage, PARP-inhibition

Core tip: There is numerous literature dealing with hypertensive heart disease and its therapeutical opportunities. In our work we have tried to combine clinical aspects with experimental data, which represent the future scope of the therapeutical opportunities in the prevention of organ damages not only via antihypertensive effect.