Pathophysiology, aetiology, epidemiology and prognosis of heart failure with reduced ejection fraction (HFrEF) is well-known. Physicians are well versed in diagnosing and treating the disease. At the same time, our knowledge is scarce about heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-ranged ejection fraction (HFmrEF). We are diagnosing these cases in a much lower number than the actual ones, and we have no morbidity and mortality-reducing evidence for treating the disease. The summary is intended to provide an overview of the epidemiology, clinical characteristics, morbidity and mortality, treatment options, the importance of the etiological diagnosis and long-term follow-up of HFmrEF and HFpEF based on currently available literature.

Hypercholesterolemia and hypertension – as the key risk factors of ischemic heart disease – are strongly linked to the increasing prevalence of cardiovascular mortality and morbidity. These risk factors are related to each other and half of the hypertensive patients have elevated cholesterol, as well. The recent European hypertension guidelines recommend statin treatment in dyslipidemic and/or subjects at high risk including diabetic or CKD-patients. Reaching blood pressure target if we can hold the patient under 1.8 mmol/l LDL-level results in 60% reduction of the risk of CAD and 17% reduction of stroke. This aim can only be reached if patients regularly take their prescribed medications although statinadherence is the poorest in our country. One of the main tools of improving adherence beyond education is the use of fix-dosed combination.

Epidemiological studies such as the NHANES III (Third National Health and Nutritional Examination Survey) have suggested that women in premenopausal state have lower blood pressure than age matched men, but after menopause (most frequently after reaching 60 years of age) this ratio turns around (1, 2). This observation leads to the possible conclusion that hormonal state, or the cessation of hormonal functions could have important role in generating high blood pressure. This hypothesis is supported by the well-described (3) numerous endothelium-preserving effects of estrogen. To decide the role of
hormonal state in generating hypertension is a complex task as cardiovascular risk and the genesis of hypertension is influenced by many other factors such as obesity, metabolic state and lipid levels, or diabetes. All these factors take important role in cardiovascular risk and are more likely to occur in older age as well (4). The logical idea of hormone replacement therapy for cardiovascular risk reduction did not work out in either secondary or primary prevention. The results of longitudinal follow-up studies and cross sectional epidemiological studies are not conclusive in the role of menopause as the cause of hypertension. This
paper summerises the possible causes of these contradictions and focuses on the main blood pressure elevating factors in the menopause without aiming to be fully exhaustive regarding the topic.