PARADOXICAL HYPERTENSION AFTER REVERSAL OF HEART-FAILURE IN PATIENTS TREATED WITH INTENSIVE VASODILATOR THERAPY

Hypertension is a major cause of heart failure, evolving from left ven tricular hypertrophy to systolic and diastolic dysfunction. Although e ffective heart failure therapy has been associated with a lowering or no change in systemic arterial blood pressure in long-term follow-up, this study describes the symptomatic, clinical, and left ventricular f unctional response of a subgroup of heart failure patients with a prio r history of hypertension who demonstrated a paradoxical hypertensive response despite high-dose vasodilator therapy. We prospectively ident ified 45 patients with a past history of hypertension who had become n ormotensive with symptomatic heart failure. Of these 45 heart failure patients, 12 became hypertensive while receiving therapy in follow-up, with systolic blood pressure greater than or equal to 140 mm Hg (Grou p A). The remaining 33 patients did not have a hypertensive response t o therapy (Group B). In the 12 Group A patients, 60 +/- 10 years old, with symptomatic heart failure far 6.3 +/- 4.3 years, vasodilator ther apy was intensified in the 2.0 +/- 0.5 years of follow-up, achieving f inal doses of enalapril 78 +/- 19 mg and isosorbide dinitrate 293 +/- 106 mg per day. New York Heart Association classification improved fro m 2.9 +/- 0.8 to 1.3 +/- 0.5 (P less than or equal to .0001), with a r eduction in heart-failure-related hospitalizations. Left ventricular e jection fraction increased from 17 +/- 6% to 40 +/- 10% (P < .0001). F ollow-up blood pressure at 1 to 3 months was unchanged. However, both systolic and diastolic blood pressure increased at final follow-up, ri sing from 116 +/- 14 to 154 +/- 13 mm Hg (P = .0001) and from 71 +/- 9 to 85 +/- 14 mm Hg (P = .004), respectively. Renal function remained unchanged. Although both groups had similar clinical responses, there were more blacks and women in the hypertensive Group A. Effectively, 1 2 of 45 (27%) heart failure patients with an antecedent history of hyp ertension demonstrated a paradoxical hypertensive response to vasodila tor therapy. The recurrence of hypertension in a significant portion o f patients successfully treated for heart failure has important clinic al implications. Am J Hypertens 1998; 11:1041-1047 (C) 1998 American J ournal of Hypertension, Ltd.