Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association

he comorbidities of hypertension, diabetes mellitus, obesity, hyperlipidemia, and metabolic syndrome are common in patients with heart failure (HF) and affect clinical outcomes.[1][2][3] Interestingly, although these comorbidities are associated with the development of incident HF in the general population, in patients with established HF, their contributory roles to clinical outcomes are not predictable, and their management is quite challenging.Recent American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines have addressed the role of lifestyle modification, 4 treatment of blood cholesterol, 5 and management of overweight and obesity 6 in the general population and in patients with increased cardiovascular risk, and a recent report from the Eighth Joint National Committee addressed the management of hypertension.7 However, these guidelines did not specifically address the management of such comorbidities in patients with HF.Similarly, the most recent ACCF/AHA HF practice guidelines 8 in 2013 addressed the overall management of comorbidities in patients with HF in broad terms, but again, specific and detailed recommendations on how to manage hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome are lacking.The intent of this AHA scientific statement is to summarize data relevant to contributory risk and to provide guidance on the management of hypertension, obesity, diabetes mellitus, hyperlipidemia, and metabolic syndrome in the development and prognosis of HF to provide recommendations (Table 1) and to foster communication between physicians and other healthcare professionals and patients on the management of these comorbidities.Recommendations in this document are based on published studies and the multidisciplinary expertise of the writing group and harmonized with published practice guidelines from the ACC/AHA [4][5][6][8][9][10][11][12] and other organizations.7,[13][14][15] HypErTENSIoN AND HFHypertension is a worldwide epidemic; in many countries, 50% of the population >60 years of age has hypertension.Hypertension is defined as a repeatedly elevated blood pressure (BP) exceeding 140/90 mm Hg.The prevalence of hypertension is steadily increasing, even with the expanded use of antihypertensive medications.16 It is widely recognized that hypertension is associated with increased cardiovascular and all-cause mortality independently of other risk factors.14,17 Specific HF mortality attributable to hypertension is probably underreported because of the competing adjudication for stroke or myocardial infarction (MI) at the end of the spectrum of hypertensive cardiovascular death.