HYPERTENSION AND HEART FAILURE

Transcription

1 HYPERTENSION AND HEART FAILURE Kenya Cardiac Society Symposium Feb 2017 Dr Jeilan Mohamed No conflict of interests

2 . Geoffrey, 45 yr old hypertensive office worker male from Nairobi, has just watched his father receive pallialon for advanced hypertensive heart failure.he asks you whether he is likely to die from Heart failure and what can be done to prevent it

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4 Which of the following is/are true? 1. He has a higher chance of gerng heart failure than his brother who is not hypertensive 2. He is more likely to die of heart failure than any other cause 3. If he gets heart failure, it is most likely to be a pure consequence of hypertension 4. It is possible to reduce his chance of developing heart failure

5 Hypertension is the Number One Risk Factor for Global Mortality High BP Tobacco High cholesterol Underweight Unsafe sex High BMI Physical inactivity Alcohol Attributable mortality in millions (total: 55,861,000) Ezzati et al. Lancet 2002;360:

6 CV Mortality Risk Doubles With Each 20/10 mm Hg BP Increment* CV mortality risk /75 135/85 155/95 175/105 SBP/DBP (mm Hg) *Individuals aged years, starting at BP 115/75 mm Hg. CV, cardiovascular; DBP, diastolic blood pressure; SBP, systolic blood pressure. Lewington S et al. Lancet. 2002;360: Chobanian AV et al. JAMA. 2003;289:

7 Framingham cohort MODE OF DEATH in Hypertension % Cardiac (MI, Heart Failure, Arrhythmia) Stroke 15 Renal 10 Other 30

8 Stroke and Myocardial Infarction are the most common mode of death in the present era.

9 BP Differences of 10 mmhg Are Associated With Up to a 40% Effect on CV Risk Meta-analysis of 61 prospective, observational studies 1 million adults 12.7 million person-years 10 mmhg decrease in mean SBP 30% reduction in risk of IHD mortality 40% reduction in risk of stroke mortality Lewington S et al. Lancet. 2002;360:

10 Stroke and Myocardial Infarction are the most common mode of death in the present era followed by heart failure and renal failure

11 Heart failure an abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen (as per) the requirements of the metabolizing tissues, despite normal filling pressures

12 What is heart failure Multi-system syndrome occurring as a (usually) due heart disease (in this case a cardiomyopathy)

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14 CHANGING PATTERN OF HEART FAILURE AETIOLOGY

15 THESUS STUDY In Africa, hypertension remains the largest cause of Acute heart failure admission

16 Reducing average blood pressure in N America

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18 Cardiomyopathy secondary to hypertension HYPERTENSIVE CARDIOMYOPATHY Direct consequence of hypertension on the cardiac muscle ISCHEMIC CARDIOMYOPATHY PLURICAUSAL CARDIOMYOPATHY

19 Left ventricular hypertrophy Rise in wall tension Sarcomere recruitment to share rise in wall tension Progression leads to Increase LV mass LV adaptive response failure due to cellular signalling and myocyte apoptosis and collagen deposition

20 ECHO patterns of hypertensive cardiomyopathy LV mass increases in both LV WALL THICKNESS / DIASTOLIC DIAMETER

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22 Concentric LVH Do patients with concentric LVH develop systolic dysfunction?

23 Relaxation and stiffness

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25 Recognising lew ventricular hypertrophy

26 Eccentric hypertrophy Occurs directly in some patients Develops as a long term maladaptive response to sustained overload in other patients Phenotypically similar to dilated cardiomyopathy

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30 Myocardial blood flow in LVH Coronary flow reserve significantly reduced in LVH Eccentric LVH up to 25% Concentric LVH up to 50% Stress-related ischemia

31 Ischemic Cardiomyopathy

32 Ischemic Heart Disease

33 ACS in Kenya Hypertension is most prevalent RF 24/02/17

34 Is pure hypertensive cardiomyopathy more reversible than other causes?

35 . Geoffrey, 45 yr old hypertensive office worker male from Nairobi, has just buried his father who died of heart failure.he asks you whether he is likely to die from Heart failure and what can be done to prevent it

36 Which of the following is/are true? 1. He has a higher chance of getting heart failure than his brother who is not hypertensive 2. He is more likely to die of heart failure than any other cause 3. If he gets heart failure, it is most likely to be a pure consequence of hypertension 4. It is possible to reduce his chance of developing heart failure

37 SUMMARY 1 Heart failure is a major killer; hypertension is a major aetiological factor 2 Maladaptive responses to hypertension can result in concentric and eccentric cardiomyopathy 3 Early control of blood pressure of hypertension can reduce the prevalence of LV hypertrophy and its consequences