Hypertensive Heart Disease: Characteristics, Symptoms, Causes, Diagnosis, Prevention, Treatment and Prognosis

This heart disease includes a number of complications from high blood pressure that affect the heart.

The heart that works under increased pressure causes a few different heart disorders.

Hypertensive heart disease includes heart failure , thickening of the heart muscle, coronary artery disease, and other conditions.

Hypertensive heart disease can be defined as cardiomyopathy that results from the myocardial response to biomechanical stress imposed on the left ventricle by progressively increasing blood pressure.

While there are several definitions of hypertensive heart disease in the medical literature, the term is widely used in the context of the International Classification of Diseases (ICD) coding categories.

The definition includes heart failure and other cardiac complications of hypertension when a causal relationship between heart disease and hypertension is established or implied on the death certificate.

In 2013, hypertensive heart disease caused 1.07 million deaths compared to 630,000 deaths in 1990.

According to the International Classification of Diseases 10th version, hypertensive heart disease (I11) and its subcategories:

Hypertensive heart disease with heart failure (I11.0) and hypertensive heart disease without heart failure (I11.9) are distinguished from chronic rheumatic heart disease (I05-I09), other forms of heart disease (I30-I52), and ischemic heart disease ( I20-I25).

However, since high blood pressure is a risk factor for atherosclerosis and ischemic heart disease, mortality rates from hypertensive heart disease provide an incomplete measure of the burden of disease due to high blood pressure .

Main features

Hypertensive heart disease is characterized by the presence of left ventricular hypertrophy.

Beyond gross hypertrophy, complex changes in the histological composition of the myocardium (which are responsible for myocardial structural remodeling) develop in hypertensive heart disease.

Hypertensive myocardial remodeling is the consequence of several pathological processes mediated by mechanical, neurohormonal, and cytokine pathways and that occur in the cardiomyocyte and non-karyomyocyte compartments of the heart.

Clinical implications

Left ventricular hypertrophy represents not only an adaptation to increased pressure load, but also an independent risk factor and risk marker for cardiovascular complications in hypertensive patients.

Hypertensive left ventricular hypertrophy is often associated with disturbances in cardiac function and electrical activity, as well as cardiac ischemia, heart failure, cardiac arrhythmias, and an increased incidence of stroke and sudden death.

Concurrent atherosclerotic coronary disease and left ventricular hypertrophy in hypertensive patients increase the risk of all cardiovascular events.

Left ventricular hypertrophy can be detected early and accurately in hypertensive patients by electrocardiography or echocardiography.

Types of hypertension

Hypertension has two types:

Primary

In primary hypertension, the disease develops over a long period of time, taking years, sometimes even decades, to show the proper symptoms.

Secondary

Secondary hypertension develops at a much faster rate and is due to health problems such as the appearance of certain diseases such as kidney disease, endocrine tumors, thyroid problems, etc.

What are the different types of hypertensive heart disease?

Some of the medical conditions found under hypertensive heart disease are mentioned in detail below:

Coronary artery disease : The job of the coronary arteries is to carry blood to the heart muscle. Chronic hypertension causes these arteries to narrow or narrow causing reduced blood flow to the heart, resulting in heart dysfunction .

This is what is called coronary artery disease. If not treated properly, this condition can have serious implications.

Cardiomegaly : Chronic hypertension makes it difficult for the heart to keep pumping blood normally, causing the heart to work harder, resulting in enlargement of the heart muscles and heart dysfunction.

Some of the other conditions that can arise due to complications of hypertensive heart disease are:

  • Heart failure.
  • Cardiac arrhythmia.
  • Ischemic heart disease.
  • Heart attack.

Signs and symptoms

Hypertension doesn’t develop overnight. It takes years to manifest. At first, one does not notice any symptoms, but that does not mean that this is a period of no harm.

The brain, kidneys, eyes, and heart are specifically susceptible. These are some of the symptoms of hypertension.

The symptoms and signs of hypertensive heart disease will depend on whether or not it is accompanied by heart failure. In the absence of heart failure, hypertension, with or without an enlarged heart (left ventricular hypertrophy) is generally asymptomatic.

Symptoms, signs, and consequences of congestive heart failure can include:

Fatigue, irregular pulse or heartbeat, swelling of the feet and ankles, weight gain, nausea, shortness of breath, trouble sleeping in bed (orthopnea), bloating and abdominal pain.

Also increased need to urinate at night, an enlarged heart (cardiomegaly), left ventricular hypertrophy and remodeling of the left ventricle, decreased coronary flow reserve and silent myocardial ischemia, coronary artery disease, and accelerated atherosclerosis.

Heart failure can develop insidiously over time, or patients can develop acute heart failure or acute decompensated heart failure and pulmonary edema due to a sudden failure of the heart’s pumping function.

Sudden failure can be precipitated by a variety of causes, including myocardial ischemia, marked increases in blood pressure, or cardiac arrhythmias.

There are good reasons why hypertension is called the “silent killer.”

Blood pressure, simply put, is the amount of force on the walls of the arteries by the blood flowing through them. If the blood pressure is too high, it puts pressure on the walls of the arteries, which can lead to thickening, and puts excessive pressure on the heart.

But a big problem is that blood pressure is not something that people can feel from day to day. No one feels the force of blood against the walls of your arteries, so you may have no idea that this is going on for a long time, until your organs and heart have been severely damaged.

Once the damage to the heart becomes severe, people may begin to have symptoms, such as chest pain or shortness of breath when walking or lying down.

High blood pressure can also damage other organs, such as the kidneys, causing swelling and rapid weight gain due to fluid retention.

However, it is possible for this type of damage to build up over years of high blood pressure without any symptoms at all, or for a sudden event like a heart attack or stroke to occur without warning.

Causes

Many factors could contribute to someone having high blood pressure. These factors are as follows:

Genetics

Some families simply have hypertension as part of their gene pool. If someone, a grandparent, a parent or a brother suffers from hypertension, one should be doubly attentive to their blood pressure readings.

Those who have a patient with high blood pressure in the family are extremely vulnerable to this medical condition.

Lifestyle choices

Our everyday life has an irreversible influence on our susceptibility to high blood pressure. Eating a diet rich in calories and processed foods, not exercising regularly, and being overweight all contribute to hypertensive disease.

Physical changes

Some other organ malfunction could raise your blood pressure. Make sure you get an annual physical every year because that keeps track of your blood pressure and the health of other organs.

Diagnosis of hypertensive heart disease

To begin, the treating physician will take a detailed history to include family history and social history. The doctor will then do a physical exam to check your blood pressure, and if you are chronically hypertensive, the following tests will be done:

Electrocardiogram : shows the heartbeat in the form of electrical impulses. This test can show if there are any abnormalities in the rhythm of the heart and if the heart is working normally.

Echocardiogram – uses ultrasound waves to observe how the heart is working. This test can accurately identify any abnormalities in the functioning of the heart.

Chest X-ray : This can reveal whether or not the heart is dilated, which can help rule out cardiomegaly as the cause of the heart murmur. In addition to these tests, you will also get a CT scan or MRI scan that can accurately detect the presence of a heart problem.

Coronary angiography : This test checks the flow of blood to and from the heart. Any abnormality in the blood flow in the heart can be confirmed through this test.

Treadmill Stress Test : This test is performed to determine the patient’s exercise tolerance and the distance the patient can cover on the treadmill before the patient begins to have symptoms. This is quite helpful in confirming the diagnosis and formulating a treatment plan.

Differential diagnosis

Other conditions may share characteristics with hypertensive heart disease and must be considered in the differential diagnosis. For instance:

Coronary artery disease or ischemic heart disease due to atherosclerosis.

  • Hypertrophic cardiomyopathy.
  • Left ventricular hypertrophy in athletes.
  • Congestive heart failure or heart failure with a normal ejection fraction from other causes.
  • Atrial fibrillation or other heart rhythm disorders due to other causes.
  • Sleep apnea .

Prevention

Hypertension or high blood pressure is one of the most common lifestyle diseases. Under this condition, the pressure exerted by the heart to pump blood increases which can lead to other complications.

One of the main reasons for increased blood pressure is narrowing of the arteries. Narrow arteries mean less room for blood to move freely.

High blood pressure for a long period of time can mean more health problems.

Because there are no symptoms with high blood pressure, people can have the condition without knowing it. Early diagnosis of high blood pressure can help prevent heart disease, stroke, eye problems, and chronic kidney disease.

The risk of cardiovascular disease and death can be reduced through lifestyle modifications, including dietary advice, promotion of weight loss and regular aerobic exercise, moderation of alcohol consumption, and smoking cessation.

Drug treatment may also be necessary to control hypertension and reduce the risk of cardiovascular disease, control heart failure, or control cardiac arrhythmias.

Patients with hypertensive heart disease should avoid taking non-steroidal anti-inflammatory drugs (NSAIDs) or cough suppressants and decongestants that contain sympathomimetics, unless otherwise directed by their doctor, as they can exacerbate hypertension and heart failure.

First, a lot can be done to prevent this problem from developing. In case you are already suffering from hypertension, the following suggestions will help to lower your blood pressure:

Healthy diet

A diet rich in fruits and vegetables, lean protein, and whole grains is good for your heart. Processed foods and junk food have a negative impact on your health.

Regular exercise

Exercising for half an hour, even two or three times a week, shows huge benefits in preventing or reducing high blood pressure.

De-stress

The stress is worse for your heart. Meditation, yoga, and deep breathing are good activities to lower high blood pressure.

Treatment

Treatment of hypertensive heart disease depends on the severity of the disease and also depends on age and medical history.

If your blood pressure readings are not in the danger zone, your doctor will suggest lifestyle changes to control your blood pressure. If those two don’t help reduce your readings, you may be prescribed medication.

If your high blood pressure is due to some other disease, your doctor will treat that problem first to lower your blood pressure.

The medical care of patients with hypertensive heart disease is classified into 2 categories:

Treatment of hypertension and prevention (and, if present, treatment) of heart failure or other cardiovascular diseases.

Some of the treatment measures taken to treat hypertensive heart disease are:

Medications: Medications will be prescribed that regulate blood flow to and from the heart and also help lower blood pressure. Some of these medications are:

Water pills for lowering blood pressure, nitrates for chest pain, statins for hypercholesterolemia, beta-blockers for blood pressure, and aspirin for preventing blood clots due to coronary artery disease.

It is important to note that you should take your medications regularly and as directed by your doctor.

Devices : In addition to medications, certain devices may be implanted to control symptoms and increase blood flow to the heart. Some of the devices used are pacemakers and defibrillators.

In severe cases of hypertensive heart disease, a heart transplant may be necessary .

Lifestyle changes : Along with medications and devices, the doctor will also recommend lifestyle changes in the form of restricting salt intake, managing weight, and maintaining a healthy lifestyle.

What is the general prognosis for hypertensive heart disease?

Full recovery from hypertensive heart disease depends on the individual’s condition and the severity of the disease.

Lifestyle changes can help the condition a lot. In severe cases, even medications or surgery may not be as effective in controlling the disease.

epidemiology

Hypertension or high blood pressure affects at least 4 billion people worldwide. Hypertensive heart disease is just one of several diseases attributable to high blood pressure.

Other diseases caused by high blood pressure include ischemic heart disease, stroke , peripheral artery disease, aneurysms, and kidney disease. Hypertension increases the risk of heart failure two to three times and probably accounts for about 25% of all heart failure cases.

Furthermore, hypertension precedes heart failure in 90% of cases, and the majority of heart failure in the elderly can be attributable to hypertension.

Hypertensive heart disease was estimated to be responsible for 1.0 million deaths worldwide in 2004 (or about 1.7% of all deaths globally), and ranked 13th among the leading causes worlds of death in all ages.

Sex differences

There are more women than men with hypertension, and although men develop hypertension earlier in life, hypertension in women is less controlled.

The consequences of high blood pressure in women are a major public health problem, and hypertension is a more important contributor to heart attacks in women than in men.

Until recently, women had not been sufficiently represented in clinical trials on hypertension and heart failure.

However, there is some evidence that the effectiveness of antihypertensive drugs differs between men and women and that treatment for heart failure may be less effective in women.

Ethnic differences

Studies in the United States indicate that a disproportionate number of African Americans have hypertension compared to non-Hispanic whites and Mexican Americans, and that they suffer a higher burden of hypertensive heart disease.

Heart failure is more common in people of African American ethnicity, mortality from heart failure is also consistently higher than in white patients, and it develops at a younger age.

Worryingly, recent data suggests that rates of hypertension are rising faster in African Americans than in other ethnic groups.

Excess high blood pressure and its consequences in African Americans is likely to contribute to their shorter life expectancy compared to white Americans.