The burden of cardiovascular disease: following the link from hypertension to myocardial infarction and heart failure.

Cardiovascular disease (CVD) is an enormous health care burden in the United States (US) and is responsible for approximately 40% of all US deaths annually. Heart failure (HF) represents the final stage of the continuum of CVD and is increasing in incidence. Between 1970 and 2000, hospital discharges for HF in the US increased 145%. This trend appears to be related to rising life expectancy and the aging of the population. Once HF develops, the long-term prognosis continues to be dismal.Hypertension is a major risk factor for CVD and the most common risk factor for the development of HF. The results of clinical trials such as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) have helped to clarify the importance of optimizing antihypertensive therapy to reduce CVD risks and development of HF. The trial also confirmed the need for multiple antihypertensive medications to reach recommended blood pressure (BP) goals in most patients. Aggressive lowering of BP is critical to help reduce the risk of CVD and help prevent the development of HF.