Hypertension -: Hypertrophy -: Heart failure:: a gradual transition?

Arterial hypertension and myocardial hypertrophy following long standing arterial hypertension are the most important prognostic factors for the development of chronic heart failure. Because of the tight epidemiologic connection between hypertensive cardiomyopathy and chronic heart failure one might ask whether there is a gradual progression from compensated myocardial hypertrophy to ouvert heart failure, myocardial hypertrophy being an early stage of this malignant disease. There are many homologies between the cellular and subcellular myocardial alterations in hypertrophy and in heart failure, e.g. alterations of the beta-adrenoceptor adenylyl cyclase pathway and the intracellular calcium homeostasis. Chronic pressure overload and consecutive myocardial neuroendocrine activation may contribute to the development of myocardial hypertrophy and chronic heart failure. Because of these pathophysiological considerations, control of arterial blood pressure and blockade of neuroendocrine activation appear both to be essential for the prevention of myocardial hypertrophy and heart failure.