Diagnosis of heart failure with preserved ejection fraction: a systematic narrative review of the evidence.

Heart failure (HF) with preserved ejection fraction (HFpEF) is a common condition in clinical practice, affecting more than half of patients with HF. HFpEF is associated with morbidity and mortality and with considerable healthcare resource utilization and costs. Therefore, early diagnosis is crucial to facilitate prompt management, particularly initiation of sodium-glucose co-transporter 2 inhibitors. Although European guidelines define HFpEF as the presence of symptoms with or without signs of HF, left ventricular EF ≥ 50%, and objective evidence of cardiac structural and/or functional abnormalities, together with elevated natriuretic peptide levels, the diagnosis of HFpEF remains challenging. First, there is no clear consensus on how HFpEF should be defined. Furthermore, diagnostic tools, such as natriuretic peptide levels and resting echocardiogram findings, are significantly limited in the diagnosis of HFpEF. As a result, some patients are overdiagnosed (i.e., elderly people with comorbidities that mimic HF), although in other cases, HFpEF is overlooked. In this manuscript, we perform a systematic narrative review of the diagnostic approach to patients with HFpEF. We also propose a comprehensible algorithm that can be easily applied in daily clinical practice and could prove useful for confirming or ruling out a diagnosis of HFpEF.

[Prevalence and clinical characteristics of microalbuminuria in the Spanish hypertensive population]. / Prevalencia y características clínicas de la microalbuminuria en la población española con hipertensión arterial.

BACKGROUND AND OBJECTIVE: The presence of microalbuminuria (MAB) in hypertension is now considered a sign of target organ damage. The aim of this study was to determine the prevalence of MAB in the Spanish hypertensive population and to correlate the degree of urinary albumin excretion (UAE) with the severity of blood pressure (BP) elevation and the presence of other cardiovascular risk factors. PATIENTS AND METHOD: Cross-sectional study of 4,952 hypertensive patients attended in primary care centres. UAE was determined in a fresh urine sample by calculating the ratio of albumin to creatinine excretion (mg/g). RESULTS: Median UAE was 13 mg/g (interquartile range, 4-29). The prevalence of MAB considered as a UAE between 30 and 300 mg/g was 21.4% with an additional 1.8% of patients having overt proteinuria (UAE > 300 mg/g). Compared with hypertensives without MAB, those who presented this feature exhibited significantly higher (p < 0,001) systolic and diastolic BP (146/85 vs 142/83 mmHg). The prevalence of MAB was also significantly higher (p < 0.001) in patients with other cardiovascular risk factors, such as hypercholesterolemia, smoking or a family history of early cardiovascular disease, and in those exhibiting other signs of target organ damage, such as left ventricular hypertrophy or mild renal insufficiency. CONCLUSIONS: MAB is present in more than 20% of the hypertensive Spanish population attended in primary care centres. There is a clear correlation between MAB and both BP elevation and the presence of other cardiovascular risk factors and signs of target organ damage.

Prevalencia y características clínicas de la microalbuminuria en la población española con hipertensión arterial / Prevalence and clinical characteristics of microalbuminuria in the Spanish hypertensive population

Fundamento y objetivo: La microalbuminuria en la hipertensión arterial se considera una lesión de órgano diana. El objetivo del presente estudio fue determinar la prevalencia de la microalbuminuria en la población hipertensa española, así como correlacionar el grado de excreción urinaria de albúmina (EUA) con la gravedad de la elevación de las cifras de presión arterial (PA) y el concurso de otros factores de riesgo cardiovascular. Pacientes y método: Estudio transversal con 4.952 pacientes hipertensos visitados en centros de atención primaria. La EUA se determinó mediante el cálculo del cociente albúmina/creatinina (mg/g) en una muestra de orina fresca. Resultados: La mediana de EUA fue de 13 mg/g (intervalo intercuartílico, 4-29). La prevalencia de la microalbuminuria (EUA entre 30 y 300 mg/g) fue del 21,4%, con un 1,8% adicional de pacientes que presentaban proteinuria (EUA > 300 mg/g). En comparación con el resto de los pacientes, los hipertensos con microalbuminuria presentaban cifras más altas de PA sistólica y dias tólica (146/85 frente a 142/83 mmHg; p < 0,001). La prevalencia de microalbuminuria fue igualmente superior (p < 0,001) en los pacientes con otros factores de riesgo, como hipercolesterolemia, tabaquismo o historia familiar de enfermedad cardiovascular precoz, así como en aquellos con otros signos de lesión de órgano diana, como hipertrofia ventricular o insuficiencia renal ligera. Conclusiones: Más del 20% de los españoles con hipertensión arterial visitados en centros de atención primaria tienen microalbuminuria. Hay una clara correlación entre la microalbuminuria y la gravedad de la elevación de las cifras de PA, el concurso de otros factores de riesgo y la lesión de órgano diana

Background and objective: The presence of microalbuminuria (MAB) in hypertension is now considered a sign of target organ damage. The aim of this study was to determine the prevalence of MAB in the Spanish hypertensive population and to correlate the degree of urinary albumin excretion (UAE) with the severity of blood pressure (BP) elevation and the presence of other cardiovascular risk factors. Patients and method: Cross-sectional study of 4,952 hypertensive patients attended in primary care centres. UAE was determined in a fresh urine sample by calculating the ratio of albumin to creatinine excretion (mg/g). Results: Median UAE was 13 mg/g (interquartile range, 4-29). The prevalence of MAB considered as a UAE between 30 and 300 mg/g was 21.4% with an additional 1.8% of patients having overt proteinuria (UAE > 300 mg/g). Compared with hypertensives without MAB, those who presented this feature exhibited significantly higher (p < 0,001) systolic and diastolic BP (146/85 vs 142/83 mmHg). The prevalence of MAB was also significantly higher (p < 0.001) in patients with other cardiovascular risk factors, such as hypercholesterolemia, smoking or a family history of early cardiovascular disease, and in those exhibiting other signs of target organ damage, such as left ventricular hypertrophy or mild renal insufficiency. Conclusions: MAB is present in more than 20% of the hypertensive Spanish population attended in primary care centres. There is a clear correlation between MAB and both BP elevation and the presence of other cardiovascular risk factors and signs of target organ damage