Hypertensive Heart Disease
Unknown authors
Abstract
Hypertensive heart disease refers to a constellation of changes in the left ventricle, left atrium, and coronary arteries as a result of chronic blood pressure elevation. Hypertension increases the workload on the heart inducing structural and functional changes in the myocardium. These changes include hypertrophy of the left ventricle, which can progress to heart failure. Patients with left ventricular hypertrophy have significantly increased morbidity and mortality, but current treatment follows standard hypertension guidelines as the effects of pharmacotherapy on regression of left ventricular hypertrophy has unclear benefits.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 disrupts the endothelial system which increases the risk of coronary artery disease and peripheral arterial disease and thus represents a significant risk factor for the development of atherosclerotic disease. However hypertensive heart disease ultimately encompasses all of the direct and indirect sequelae of chronic high blood pressure which include systolic or diastolic heart failure, conduction arrhythmia especially atrial fibrillation, and increased risk of coronary artery disease.