Development of heart failure in recent hypertension trials

Background Heart failure represents a major cause of disease burden worldwide and is expected to further rise in the coming decades. Hypertension is the clinical condition most frequently associated to heart failure. Objective To systematically review the incidence of heart failure compared to coronary heart diseases and stroke in recent hypertension trials. Methods We identified 23 trials concluded within the last decade including 193 424 patients with hypertension or at 'high' cardiovascular risk with a predominant presence of hypertensive patients, and reported incidence of major cardiovascular events, including heart failure, coronary heart disease and stroke. Results A total of 24 837 major cardiovascular events were recorded in trials performed between 1997 and 2007, of which 7171 (28.9%) were cases of heart failure, 10 223 (41.1%) of coronary heart disease and 7443 (30.0%) of stroke. The rate of heart failure was comparable with that of stroke, accounting for 8.5 and 9.1 events per 1000 patients (PUNS), respectively. Heart failure development was more prevalent in older subjects (> 65 years) [odds ratio: 3.08, confidence interval 95% (2.88-3.31); P < 0.0001], in black versus nonblack individuals [odds ratio 1.90, (1.76-2.06); P < 0.0001], in diabetic versus nondiabetic patients [odds ratio 4.91, 95% confidence interval (4.40-5.43); P < 0.0001] and in patients with very high' risk versus those with a 'very high' risk profile [odds ratio 1.29, 95% confidence interval (1.23-1.36); P < 0.0001]. Conclusion Our analysis shows that heart failure development remains a major problem in hypertension. In recent trials on hypertension, the development of heart failure was found comparable with that of stroke: it is more prevalent in older, black, diabetic and 'very high' risk individuals. These findings highlight the relevance of heart failure development in hypertension and support the need for optimizing antihypertensive strategies aimed at preventing the progression to overt heart failure, thus reducing the growing burden of disease associated with hypertension.