JAMA 8 November 2006

As many people get older, they become fatter and their blood pressure rises. Some become diabetic. To maintain cardiac output, heart myocytes hypertrophy and stay hypertrophied over long periods, causing some of them to die early (apoptosis), and giving rise in the long term to a stiff left ventricle. At the same time, the large capacitance arteries lose a lot of their elasticity, causing them to reflect an increasing pressure wave back at the heart during systole. During diastole, the left ventricle and the coronary arteries fill less effectively, and eventually a syndrome of heart failure with preserved ejection fraction results. Because our classic model of “heart failure