Hypertensive heart disease

Signs and symptoms

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 enlargement of the heart (left ventricular hypertrophy) is usually symptomless.

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

• Fatigue
• Irregular pulse or palpitations
• Swelling of feet and ankles
• Weight gain
• Nausea
• Shortness of breath
• Difficulty sleeping flat in bed (orthopnea)
• Bloating and abdominal pain
• Greater need to urinate at night
• An enlarged heart (cardiomegaly)
• Left ventricular hypertrophy and left ventricular remodeling
• Diminished coronary flow reserve and silent myocardial ischemia
• Coronary heart disease and accelerated atherosclerosis
• Heart failure with normal left ventricular ejection fraction (HFNEF), often termed diastolic heart failure
• Atrial fibrillation, other cardiac arrhythmias, or sudden cardiac death Heart failure can develop insidiously over time or patients can present acutely with acute heart failure or acute decompensated heart failure and pulmonary edema due to sudden failure of pump function of the heart. Sudden failure can be precipitated by a variety of causes, including myocardial ischemia, marked increases in blood pressure, or cardiac arrhythmias.

Diagnosis

Differential diagnosis

Other conditions can share features with hypertensive heart disease and need to be considered in the differential diagnosis. For example:

• Coronary artery disease or ischemic heart diseases due to atherosclerosis
• Hypertrophic cardiomyopathy
• Left ventricular hypertrophy in athletes
• Congestive heart failure or heart failure with normal ejection fraction due to other causes
• Atrial fibrillation or other disorders of cardiac rhythm due to other causes
• Sleep apnea

Prevention

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

The risk of cardiovascular disease and death can be reduced by lifestyle modifications, including dietary advice, promotion of weight loss and regular aerobic exercise, moderation of alcohol intake and cessation of smoking. or control cardiac arrhythmias. Patients with hypertensive heart disease should avoid taking over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), or cough suppressants, and decongestants containing sympathomimetics, unless otherwise advised by their physician as these can exacerbate hypertension and heart failure.

Blood pressure goals

According to JNC 7, BP goals should be as follows:

• Less than 140/90mm Hg in patients with uncomplicated hypertension
• Less than 130/85mm Hg in patients with diabetes and those with renal disease with less than 1g/24-hour proteinuria
• Less than 125/75mm Hg in patients with renal disease and more than 1 g/24-hour proteinuria

Treatment

The medical care of patients with hypertensive heart disease falls under 2 categories—

• Treatment of hypertension
• Prevention (and, if present, treatment) of heart failure or other cardiovascular disease

Epidemiology

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Hypertension or high blood pressure affects at least 26.4% of the world's population. Hypertensive heart disease is only one of several diseases attributable to high blood pressure. Other diseases caused by high blood pressure include ischemic heart disease, cancer, stroke, peripheral arterial disease, aneurysms and kidney disease. Hypertension increases the risk of heart failure by two or three-fold In addition, hypertension precedes heart failure in 90% of cases, Hypertensive heart disease was estimated to be responsible for 1.0 million deaths worldwide in 2004 (or approximately 1.7% of all deaths globally), and was ranked 13th in the leading global causes of death for all ages. A world map shows the estimated disability-adjusted life years per 100,000 inhabitants lost due to hypertensive heart disease in 2004.

Sex differences

There are more women than men with hypertension,{{cite journal |last1=Kearney |first1=Patricia M |last2= Whelton |first2= Megan|last3= Reynolds |first3= Kristi |last4= Whelton |first4= Paul K |last5= He |first5= Jiang and, although men develop hypertension earlier in life, hypertension in women is less well controlled. The consequences of high blood pressure in women are a major public health problem and hypertension is a more important contributory factor in heart attacks in women than men. Until recently women have been under-represented in clinical trials in hypertension and heart failure. Nevertheless, 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 US indicate that a disproportionate number of African Americans have hypertension compared with non-Hispanic whites and Mexican Americans, and that they have a greater 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 an earlier age. Recent data suggests that rates of hypertension are increasing more rapidly in African Americans than other ethnic groups. The excess of high blood pressure and its consequences in African Americans is likely to contribute to their shorter life expectancy compared with white Americans.

References

References

1. (April 2006). "Hypertensive heart disease: a proposed clinical classification". [[Revista Española de Cardiología]].
2. (2009). "Hypertensive heart disease: a new clinical classification (VIA)". e-Journal of the European Society of Cardiology Council for Cardiology Practice.
3. (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.". Lancet.
4. (August 1996). "Diabetic and hypertensive heart disease". [[Annals of Internal Medicine]].
5. (March 2009). "Heart failure with normal left ventricular ejection fraction". [[Journal of the American College of Cardiology]].
6. (May 21, 2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". [[JAMA (journal).
7. "Hypertensive heart disease". Medline Plus.
8. (April 2009). "2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation". [[Circulation (journal).
9. (March 2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". [[Journal of the American College of Cardiology]].
10. (April 2007). "Cardiovascular risk, hypertension, and NSAIDs". [[Current Rheumatology Reports]].
11. (June 1999). "Use of nonprescription medications by patients with congestive heart failure". [[Annals of Pharmacotherapy]].
12. Riaz, Kamran. "Hypertensive Heart Disease". Medscape Reference.
13. (2009). "WHO Disease and injury country estimates". World Health Organization.
14. (2005). "Global burden of hypertension: analysis of worldwide data". [[The Lancet]].
15. World Health Organization. (2008). "The Global Burden of Disease: 2004 Update". World Health Organization.
16. (June 2008). "Reporting on sex-based analysis in clinical trials of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker efficacy". [[Canadian Journal of Cardiology]].
17. (July 2005). "Hypertension in adults across the age spectrum: current outcomes and control in the community". [[JAMA (journal).
18. (November 2000). "Hypertension and its treatment in postmenopausal women: baseline data from the Women's Health Initiative". [[Hypertension (journal).
19. (January 2011). "Epidemiology and risk profile of heart failure". [[Nature Reviews Cardiology]].
20. (January 2006). "Hypertension-related morbidity and mortality in African Americans—why we need to do better". Journal of Clinical Hypertension (Greenwich).
21. (April 2008). "Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study)". [[American Journal of Cardiology]].
22. (January 2009). "Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee". [[Circulation (journal).