Figure 3.

Cardiac remodeling in hypertensive heart failure (HHF). According to the spectrum theory, each HF phenotype results from a patient-specific trajectory where the heart remodels towards concentric left ventricular hypertrophy (LVH), eccentric LVH, or a combination of the two. In the case of hypertension (HTN), the port of entry in the HF spectrum (HHF entry phenotype) depends on (a) HTN severity, duration and antihypertensive treatment effectiveness; (b) the balance between LV pressure and LV volume overload; (c) the coexistence of morbidities such as obesity, diabetes mellitus, and coronary artery disease; and (d) disease modifiers (age, sex, genes, other). The eventual HHF phenotype results from transitions across the HF spectrum, whose direction predominantly depends on disease severity and antihypertensive treatment, which shift towards the lower end of upper end of the HF spectrum, respectively.