Epidemiologic Insights into Progression from Hypertension to Heart Failure

Review of national vital and health statistics and the epidemiology of cardiac failure indicates that it is a common end-stage of heart disease and a major burden on individuals and the health care systems of many countries. Morbidity and mortality attributed to it are high, survival is poor and treatment is inadequate. Heart failure ranks high in causes of hospitalizations in the US following childbirth, pneumonia, psychosis and fractures, and it is the leading diagnosis for hospitalizations of patients over age 65 years [1]. The hospitalization rate for heart failure for persons aged 45–64 years increased from 8.2 per 10 000 in 1971 to 33.8 per 10 000 in 1994. The continued rise in the prevalence of this condition over recent decades and its persistent high mortality rate contrasts with observed major mortality reductions from other cardiovascular events [2, 3]. These trends have made heart failure a major problem with a profound economic impact on the health care system. It is estimated that 4.8 million Americans have heart failure, 400 000 developing it yearly. In 1994 there were nearly 3 million office visits for heart failure [2, 3].