Importance of Vascular Function in Patients with Heart Failure with Preserved Ejection Fraction

Main Article Content

Shunsuke Kiuchi, MD, PhD Takanori Ikeda, MD, PhD


There had been no effective cardioprotective medications for heart failure with preserved ejection fraction (HFpEF). Therefore, treatment intervention at the hypertension (HT) stage (stage A), which is a major factor in HFpEF, is necessary. In fact, the SPRINT and STEP trials reported that strict and intensive blood pressure (BP) control was useful, reducing approximately 25% of the primary endpoints, including cardiovascular events. The effectiveness of BP reduction for HFpEF after the onset of HF (stage C or D) has been reported and shown to generally follow the J-curve phenomenon. Both left ventricular systolic/diastolic dysfunction and vascular failure are related with the pathophysiology of HF. In the case of coexisting vascular failure, BP lowering treatment is effective, because it decreases the afterload. However, BP lowering treatment has been reported to increase the incidence of renal dysfunction; therefore, paying attention to the degree of association with vascular failure, and multiple organs when determining the target BP are important to consider. The decision on the target BP and the optimal choice of cardioprotective/antihypertensive medications for HF should be based on the pathologic condition.

Article Details

How to Cite
KIUCHI, Shunsuke; IKEDA, Takanori. Importance of Vascular Function in Patients with Heart Failure with Preserved Ejection Fraction. Medical Research Archives, [S.l.], v. 10, n. 5, june 2022. ISSN 2375-1924. Available at: <>. Date accessed: 25 june 2022. doi:
Review Articles


1. Okura Y, Ramadan MM, Ohno Y, et al. Impending epidemic: future projection of heart failure in Japan to the year 2055. Circ J 2008; 72: 489-491.
2. Schmidt M, Ulrichsen SP, Pedersen L, Botker HE, Sorensen HT. Thirty-year trends in heart failure hospitalization and mortality rates and the prognostic impact of co-morbidity: a Danish nationwide cohort study. Eur J Heart Fail. 2016; 18: 490-499.
3. Christ M, Stork S, Dorr M, et al; Trend HF Germany Project. Heart failure epidemiology 2000–2013: insights from the German Federal Health Monitoring System. Eur J Heart Fail. 2016; 18: 1009-1018.
4. Ejiri K, Noriyasu T, Nakamura K, Ito H. Unprecedented crisis-Heart failure hospitalizations in current or future Japan. J Cardiol. 2019; 74: 426-427.
5. Ide T, Kaku H, Matsushima S, et al, the JROADHF Investigators. Clinical Characteristics and Outcomes of Hospitalized Patients With Heart Failure From the Large-Scale Japanese Registry Of Acute Decompensated Heart Failure (JROADHF). Circ J. 2021; 85: 1438-1450.
6. Guidelines for Diagnosis and Treatment of Acute and Chronic Heart Failure (JCS 2017/JHFS 2017). guideline/pdf/JCS2017_tsutsui_h/pdf, Accessed 3 April 2022
7. McDonagh TA, Metra M, Adamo M, et al; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42: 3599-3726.
8. Carolyn S P Lam, Javed Butler. Victims of Success in Failure. Circulation. 2020;142:1129-1131.
9. Kiuchi S, Hisatake S, Kabuki T, et al. Azelnidipine is a useful medication for the treatment of heart failure preserved ejection fraction. Clin Exp Hypertens. 2017; 39: 350-354.
10. Shimokawa H, Miura M, Nochioka K, Sakata Y. Heart failure as a general pandemic in Asia. Eur J Heart Fail. 2015; 17: 884-892.
11. Tsuchihashi-Makaya M, Hamaguchi S, Kinugawa S, et al; JCARE-CARD Investigators. Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction. Report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J. 2009; 73: 1893-1900.
12. Galderisi M. Diagnosis and management of left ventricular diastolic dysfunction in the hypertensive patient. Am J Hypertens. 2011; 24: 507-517.
13. Kannan A, Janardhanan R.Hypertension as a risk factor for heart failure. Curr Hypertens Rep. 2014; 16: 447.
14. Faggiano P, Bernardi N, Calvi E, Bonelli A, Faggiano A, Bursi F, Bosisio M. Stage A Heart Failure: Modern Strategies for an Effective Prevention. Heart Fail Clin. 2021; 17: 167-177.
15. Lewis CE, Fine LJ, Beddhu S, Cheung AK, et al. SPRINT Research Group. Final Report of a Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2021; 384: 1921-1930.
16. Zhang W, Zhang S, Deng Y, et al; STEP Study Group. Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. N Engl J Med. 2021; 385: 1268-1279.
17. Kiuchi S, Ikeda T. Management of hypertension associated with cardiovascular failure. J Cardiol. 2021; doi: 10.1016/j.jjcc.2021.11.012.
18. Soliman EZ, Ambrosius WT, Cushman WC, et al; SPRINT Research Study Group. Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial). Circulation. 2017; 136: 440-450.
19. Verdecchia P, Carini G, Circo A, et al; MAVI Study Group. Left ventricular mass and cardiovascular morbidity in essential hypertension: the MAVI study. J Am Coll Cardiol. 2001; 38: 1829-1835.
20. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment. 6. Prevention of heart failure and new-onset heart failure--meta-analyses of randomized trials. J Hypertens. 2016; 34: 373-384.
21. Ekström M, Hellman A, Hasselström J, et al. The transition from hypertension to hypertensive heart disease and heart failure: the PREFERS Hypertension study. ESC Heart Fail. 2020; 7: 737-746.
22. Mei CC, Zhang J, Jing HX. Fluid mechanics of Windkessel effect. Med Biol Eng Comput. 2018; 56: 1357-1366.
23. Sano T, Kiuchi S, Hisatake S, et al. Cardio-ankle vascular index predicts the 1-year prognosis of heart failure patients categorized in clinical scenario 1. Heart Vessels. 2020; 35: 1537-1544.
24. Tokitsu T, Yamamoto E, Hirata Y, et al. Clinical significance of pulse pressure in patients with heart failure with preserved left ventricular ejection fraction. Eur J Heart Fail. 2016; 18: 1353-1361.
25. Cotter G, Felker GM, Adams KF, Milo-Cotter O, O'Connor CM. The pathophysiology of acute heart failure--is it all about fluid accumulation? Am Heart J. 2008; 155: 9-18.
26. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017; 136: e137-e161.
27. Kawano H, Fujiwara A, Kai H, et al. Effects of blood pressure lowering in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis. Hypertens Res. 2019; 42: 504-513.
28. Selvaraj S, Claggett B, Shah SJ, et al. Systolic blood pressure and cardiovascular outcomes in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial. Eur J Heart Fail. 2018; 20: 483-490.
29. Lee SE, Lee HY, Cho HJ, et al. Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure. JACC Heart Fail. 2017; 5: 810-819.
30. Schwartzenberg S, Redfield MM, From AM, Sorajja P, Nishimura RA, Borlaug BA. Effects of vasodilation in heart failure with preserved or reduced ejection fraction implications of distinct pathophysiologies on response to therapy. J Am Coll Cardiol. 2012; 59: 442-451.
31. Núñez J, Núñez E, Fonarow GC, et al. Differential prognostic effect of systolic blood pressure on mortality according to left-ventricular function in patients with acute heart failure. Eur J Heart Fail. 2010; 12: 38-44.