Introduction
Hypertensive heart disease (HHD), as per name suggests, is a group of heart disorders that develops due to consistently high blood pressure over the years. High blood pressure increases pressure on the heart tissue, which gets enlarged and dilated, degrading its function further.
Hypertensive heart disease includes:
- left ventricular hypertrophy, which is the main cause of heart failure in adults.
- Systolic and diastolic dysfunction.
- Heart arrhythmias.
- Other cardiovascular conditions like coronary artery diseases.
Associated Anatomy
Cardiovascular system (heart, arteries, veins)
Causes of hypertensive heart disease
HHD is an interplay of various factors which are:
- Chronic high blood pressure: Hypertension over the years is the main cause behind this condition
- Advanced age: Chances of hypertension and heart disease increase after 65 years of age.
- Obesity: High cholesterol levels are a significant risk factor for HHD.
- Lack of physical activity.
- Diet rich in trans fats and sodium.
- Alcohol intake and smoking.
Signs and symptoms
Hypertensive heart disease presents with several signs and symptoms which are
- Very high blood pressure >140/90.
- Irregular palpitations
- Shortness of breath
- Dizziness and headaches
- Chronic fatigue
- Chest pain during exertion
- Cardiomegaly (enlarged heart muscle)
- An episode of myocardial infarction (MI) or heart attack.
Typical test to diagnose hypertensive heart disease
The doctors diagnose this condition through clinical examinations, medical history and through various diagnostic tests which are:
- Transthoracic Echocardiogram: It is a very sensitive test for diagnosing left ventricular hypertrophy.
- Electrocardiogram (ECG or EKG): It is the typical test that measures the electrical activity and abnormal enlargement of heart tissue due to this condition
- Lipid Profile: This is the basic test conducted if doctors suspect any condition related to hypertension and heart to check the levels of HDL, LDL, and triglycerides.
- Urine Test: It is done to assess the presence of proteins in urine
- Other tests like thyroid profile, complete blood count, and kidney function tests.
Treatment of hypertensive heart disease
The treatment of hypertensive heart disease is targeted to lower blood pressure to optimum level and prevent heart failure. After assessment of the reports, different groups of antihypertensive medications are given to these patients as monotherapy (only one drug at a time) or in combination with other medications such as
- Thiazides or Diuretics: Hydrochlorothiazide, indapamide, etc.
- Beta-blockers: Metoprolol, bisoprolol.
- Angiotensin-converting enzyme inhibitors (ACE inhibitors): Enalapril, Ramipril, etc.
- Calcium channel blockers: Amlodipine, clinidipine
Lifestyle modifications include:
- Losing weight.
- Reducing salt intake.
- Regular physical exercise.
- Eliminating junk food and smoking.
- Limiting alcohol intake.
- Having a diet rich in fruits, vegetables, and fiber.
Surgical treatment involves
- Coronary artery bypass graft surgery (CABG) for treating blocked arteries in severe cases of heart failure.
Risk factors for hypertensive heart disease
Various risk factors are associated with hypertensive heart disease
- Age: Chances of the hypertensive heart disease increase with an increase in age
- Gender: Females are more prone to this condition than men.
- Ethnicity: It is more common in the African-American race than among Caucasians.
- Chronic High blood pressure over the years
- Diabetes: This also adds to the risk of developing HHD.
Stages of hypertensive heart disease
Based on the degree or extent of tissue damage, it is divided into
- Degree I: Diastolic dysfunctions begin to appear with no muscle enlargement.
- Degree Il: Diastolic dysfunction still persists, along with the beginning of heart muscle enlargement.
- Degree Ill: It is the stage of heart failure with no compromise in blood pumping capacity of the heart (LV ejection.)
- Degree IV: The heart muscle is quite enlarged in this stage, along with the reduced capacity to pump blood to the body.
Primary prevention of hypertensive heart disease
- The foremost thing to prevent hypertension and heart disease is to control the blood pressure.
- This condition develops over the years, hence early diagnosis with timely treatment which includes making lifestyle modifications, losing weight, doing physical activity regularly, and monitoring the diet and salt intake is the key to preventing this fatal condition.
Secondary prevention of hypertensive heart disease
- After the diagnosis, it is imperative to stick to a strict diet regime with regular exercise to control blood pressure and maintain weight.
- With medicines and lifestyle changes, one can prevent the chances of heart failure and other heart-related issues in due course of time.
Alternate name
Left ventricular hypertrophy.
Differential diagnosis
Hypertensive heart disease is a complicated condition that resembles other conditions related to the heart such as:
- Cardiomyopathy.
- Disorders of heart valves (aortic stenosis.)
- Coronary artery disease.
- Sleep apnea.
Epidemiology
Hypertensive heart disease in adults has increased considerably in the last few decades. Globally, 19.60 million were documented in 2019. India has the third-highest prevalence of HHD cases in the world.
Prognosis of hypertensive heart disease
The outcome of this condition varies among different individuals. Hypertensive heart disease causes a lot of morbidity among its patients. However, by reducing different modifiable risk factors (quitting smoking and alcohol, exercising) and appropriate medications can reduce its progression.
Natural Progression of hypertensive heart disease
In absence of any treatment, this condition damages the heart muscle to an extent that it fails to pump blood effectively. This leads to various conditions like heart palpitations, and coronary artery diseases and eventually causes death. It also causes CKD and other end organ damage example brain (CVA), Eye ( retinal detachment).
Pathophysiology of hypertensive heart disease
In this condition, the heart muscle thickens due to constant elevation of blood pressure over time. This eventually causes dilation of the left ventricle muscle, which is the main muscle of the heart for pumping blood into the body. Over time, this weakens the heart muscle to pump blood effectively, leading to the death of heart muscles culminating in heart failure.
Possible complications of hypertensive heart disease
Hypertensive heart disease is a debilitating condition that increases the chances of other heart and endorgan dysfunction conditions, which include:
- Stroke.
- Heart failure.
- Cardiac arrest or heart attack.
- Retinal damage.
- Chronic kidney disease.
- Atherosclerosis.
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