Kamran Riaz, MD Clinical Assistant Professor, Department of Internal Medicine, Section of Cardiology, Wright State University, Boonshoft School of Medicine. Kamran Riaz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Society of Echocardiography, Ohio State Medical Association, and Royal College of Physicians

Hypertensive Heart Disease

Overview
The cause of hypertensive heart disease is chronically elevated blood pressure (BP); however, the causes of elevated BP are diverse. Essential hypertension accounts for 90% of cases of hypertension in adults. Secondary causes of hypertension account for the remaining 10% of cases of chronically elevated BP.

According to the Framingham Study, hypertension accounts for about one quarter of heart failure cases. In the elderly population, as many as 68% of heart failure cases are attributed to hypertension. Community-based studies have demonstrated that hypertension may contribute to the development of heart failure in as many as 50-60% of patients. In patients with hypertension, the risk of heart failure is increased by 2-fold in men and by 3-fold in women.

Cardiovascular effects of hypertension
Uncontrolled and prolonged elevation of BP can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart. These changes in turn can lead to the development of left ventricular hypertrophy(LVH), coronary artery disease (CAD), various conduction system diseases, and systolic and diastolic dysfunction of the myocardium, complications that manifest clinically as angina or myocardial infarction, cardiac arrhythmias (especially atrial fibrillation), and congestive heart failure (CHF).

Thus, hypertensive heart disease is a term applied generally to heart diseases, such as LVH, coronary artery disease, cardiac arrhythmias, and CHF, that are caused by the direct or indirect effects of elevated BP. Although these diseases generally develop in response to chronically elevated BP, marked and acute elevation of BP can lead to accentuation of an underlying predisposition to any of the symptoms traditionally associated with chronic hypertension.

Differentials
The following conditions should also be considered when evaluating hypertensive heart disease:

Coronary artery atherosclerosis
Hypertrophic cardiomyopathy
Athlete’s heart (with LVH)
Congestive heart failure due to other etiologies
Atrial fibrillation due to other etiologies
Diastolic dysfunction due to other etiologies
Sleep apnea

Patient education
It is important to educate patients about the nature of their disease and the risks associated with untreated hypertension. In addition, dietary modifications and the importance of regular exercise, taking medications regularly, weight loss, and avoiding medications and foods that can potentially elevate blood pressure should be emphasized.

This is a long and comprehensive article, so I have posted an overview.