Overview

Blood pressure is a simple measurement that assesses the interaction of heart function with vascular impedance. When heart function is normal, the impedance is the main determinant of blood pressure. Therefore, pressure (systolic and mean) becomes a powerful risk factor for development of left ventricular (LV) hypertrophy, increased myocardial oxygen consumption, coronary atherosclerosis, and subsequent heart failure (HF).1,2 Control of blood pressure in this setting is critical to prevent the development and progression of LV dysfunction.3

When LV function is impaired, however, the relationship between impedance and cardiac function becomes more complex. Increases of impedance may impair LV emptying and thus not be reflected in a higher pressure. Under those circumstances therapy is aimed at the impedance, not at the blood pressure. Indeed, blood pressure may rise in response to effective therapy that improves LV emptying or reverses remodeling even if the impedance is reduced.