Problems in treating patients with high-risk arterial hypertension: focussing on diastolic heart failure

Currently, the prevalence of diastolic chronic heart failure (DCHF) in the population of chronic heart failure (CHF) patients reaches 40-55 %, being as high as >= 73 % in Russia. The prevalence of DCHF is higher in older age groups and women. The CHF diagnosis is mostly based on clinical examination of the patient, since a standard assessment of E/A ratio is often not informative enough. Detailed assessment of diastolic function requires measurement of heart wall thickness and atrial sizes during four-chamber position echocardiography. According to the European clinical guidelines, the leading role in diastolic function assessment belongs to E/Em parameter, reflecting early diastolic mitral flow E and early diastolic myocardial relaxation. An increase in E/Em up to 8-15 is a sign of diastolic dysfunction. Despite substantial advances in the treatment of CHF with decreased ejection fraction, currently, there are no medications for the treatment of DCHF with effectiveness demonstrated in large-scale randomised clinical trials. Therefore, the present approaches to DCHF treatment remain empirically based.