Hypertensive heart disease

Overview 

Hypertensive heart disease is characterized by a series of alterations in the left ventricle, left atrium, and coronary arteries caused by prolonged blood pressure increase. Hypertension puts more strain on the heart, causing anatomical and functional alterations in the myocardium. These alterations include left ventricular enlargement, which can lead to heart failure. Patients with left ventricular hypertrophy have much higher morbidity and mortality, although current treatment adheres to typical hypertension recommendations since the effects of medication on regression of left ventricular hypertrophy are unknown.

Hypertensive heart disease is subclassified by the presence or absence of heart failure as the management of heart failure requires more intensive goal-directed therapy. Hypertensive heart disease can lead to either diastolic heart failure, systolic failure, or a combination of the two. Such patients are at a higher risk for developing acute complications such as decompensated heart failure, acute coronary syndrome, or sudden cardiac death. 

Hypertension disturbs the endothelium system, increasing the risk of coronary artery disease and peripheral arterial disease, and is thus a substantial risk factor for the development of atherosclerotic disease. However, hypertensive heart disease eventually incorporates all of the direct and indirect consequences of persistent high blood pressure, such as systolic or diastolic heart failure, conduction arrhythmia, particularly atrial fibrillation, and an increased risk of coronary artery disease.