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Hypertensive Heart Disease: Symptoms, Diagnosis, and Treatment

Hypertensive Heart Disease: Symptoms, Diagnosis, and Treatment

  • January 24, 2020
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Hypertensive heart disease refers to heart problems that occur due to high blood pressure that has lasted a long time. It is the No. 1 cause of death associated with high blood pressure.

High blood pressure means that the pressure in the blood vessels (arteries) is too high. When the heart pumps against this pressure, the heart must work harder making the heart muscle to thicken with time.

Because there are often no symptoms of high blood pressure, people can have problems without realizing it. Symptoms most often appear after years of poor blood pressure control when heart damage occurs.

Without treatment for high blood pressure, symptoms of heart failure can occur. Sometimes the muscles are so thick that they don’t get enough oxygen. This can cause chest pain.

High blood pressure also causes the walls of blood vessels to thicken. In combination with cholesterol deposits in blood vessels, the risk of heart attack and stroke increases.

The heart, when working under high pressure, causes several different heart diseases. Hypertensive Heart Disease includes heart failure, thickening of the heart muscle, coronary artery disease and other diseases.

Hypertensive heart disease is a leading cause of death associated with high blood pressure. It can cause serious health problems.

Hypertensive heart disease refers to a group of disorders that includes: 

  • heart failure,
  • ischemic heart disease
  • left ventricular hypertrophy.

Heart Failure

Heart failure does not mean the heart stops working. On the contrary, it means that the heart’s pumping capacity is lower than normal or the heart becomes less elastic. With heart failure, blood flows less efficiently through the heart’s pumping chamber, and the pressure in the heart increases. This makes it difficult for your heart to send oxygen and nutrients to your body.

To compensate for the reduced pumping power, the heart’s chamber expands and holds more blood. This keeps the blood moving, but over time, the heart muscle walls can weaken and become less watery. As a result, the kidneys often respond, causing the body to retain sodium and fluids (water). This fluid accumulates in the hands, feet, ankles, legs, lungs or other organs and is known as congestive heart failure. Some of the symptoms of heart failure include:

  • Shortness of breath/difficulty in breathing
  • Swelling in the soles, ankles, or stomach
  • Difficult to sleep flat in bed
  • Bloating
  • Uneven heartbeat
  • Nausea
  • Fatigue
  • Increased urination at night.

Ischemic Heart Disease

High blood pressure can also cause ischemic heart disease. This means that the heart muscle does not get enough blood. Ischemic heart disease is usually a result of arteriosclerosis or hardening of the arteries (coronary artery disease), which prevents blood from flowing into the heart. Some of the symptoms of ischemic heart disease include:

  • Chest pain that can spread to the arms, back, neck or jaw
  • Chest pain with nausea, sweating, difficulty breathing and dizziness; these related symptoms can also occur without chest pain
  • Uneven heartbeat
  • Fatigue and weakness

These symptoms of ischemic heart disease require immediate medical examination.

Left Ventricular Hypertrophy

High blood pressure can also cause left ventricular hypertrophy, a thickening of the heart muscle, which causes less effective muscle relaxation between heartbeats. This makes it difficult for the heart to fill itself with enough blood to supply organs, especially when exercising, which causes your body to hold onto fluid and your heart rate to increase.

Causes of Hypertension

Types of Hypertension

In general, heart problems related to high blood pressure affect the arteries and muscles of the heart. Types of hypertensive heart disease are:

Narrowing of the Arteries

Coronary arteries carry blood to the heart muscle. If blood vessels constrict due to high blood pressure, blood flow to the heart may slow or stop. This condition is known as coronary artery disease, which is also known as coronary heart disease.

Coronary artery disease makes it hard for your heart to work and supply blood to other organs. This can cause you to have a heart attack from a blood clot stuck in one of the narrowed arteries and stop the flow of blood to your heart.

Thickening and Enlargement of the Heart

High blood pressure makes it hard for your heart to pump blood. Like other muscles in your body, regular hard work will thicken and enlarge the heart muscle. This changes the way the heart works. These changes usually occur in the main pumping chamber, the left ventricle. This disease is called left ventricular hypertrophy (LVH).

Causes of Hypertensive Heart Disease

Coronary heart disease can cause left ventricular hypertrophy and vice versa. If you have coronary heart disease, your heart must work harder. When left ventricular hypertrophy widens your heart, it can compress coronary arteries.

Both coronary artery disease and left ventricular hypertrophy may cause:

  • Heart failure: your heart cannot pump enough blood throughout the body
  • Arrhythmia: Your heartbeat is abnormal
  • Ischemic heart disease: Your heart is not getting enough oxygen
  • Heart attack: Blood flow to the heart is interrupted and the heart muscle dies due to lack of oxygen
  • Sudden cardiac arrest: your heart suddenly stops working, you stop breathing and you lose consciousness
  • Stroke and sudden death.

Causes of Hypertensive Heart Disease

The causes of hypertensive heart disease are chronic high blood pressure; however, there are many reasons for the increase in blood pressure. Essential hypertension accounts for 90% of cases of hypertensive heart disease in adults. The secondary cause of hypertension is the remaining 10% of cases of chronic blood pressure.

According to the Framingham study, hypertension accounts for about a quarter of all cases of heart failure. In the elderly, up to 68% of cases of heart failure are caused by hypertension. Community studies show that hypertension can contribute to the development of heart failure in about 50-60% of patients. In patients with high blood pressure, the risk of heart failure is 2 times higher in men and 3 times higher in women.

The cause of high blood pressure is often unknown. In many cases, this is caused by underlying conditions.

Doctors call hypertension, which is not due to other diseases, primary or essential hypertension.

When the underlying condition causes an increase in blood pressure, doctors call it secondary hypertension.

Primary hypertension can be the result of many factors, including:

  • Blood plasma volume
  • Hormonal activity in people who use drugs to control blood volume and blood pressure
  • Environmental factors such as stress and lack of exercise.

Secondary hypertension has a specific cause and is a complication of other health problems.

Chronic kidney disease is a common cause of high blood pressure because the kidneys no longer filter fluids. This excess fluid causes hypertension.

Conditions that can cause hypertensive heart disease include:

  • Diabetes due to kidney problems and nerve damage
  • Kidney disease
  • Pheochromocytoma, a rare adrenal cancer
  • Cushing syndrome, which can be caused by corticosteroid drugs
  • Congenital adrenal hyperplasia, injury to the adrenal gland that secretes cortisol
  • Hyperthyroidism or overactive thyroid
  • Hyperparathyroidism which affects calcium and phosphate levels
  • Pregnancy
  • Sleep apnea
  • Obesity.

Diagnosis of Hypertensive Heart Disease

Your doctor will review your medical history, do a physical examination, and do laboratory tests to check your kidney, sodium, potassium, and blood counts. He will look for certain symptoms of hypertensive heart disease, including:

  • High blood pressure
  • Enlarged heart
  • Irregular heartbeat
  • Fluid in the lungs or lower extremities
  • Unusual heart sounds.

Your doctor may use one or more of the following tests to determine the cause of your symptoms:

  • Electrocardiogram: An electrocardiogram monitors and records the electrical activity of your heart. Your doctor will patch your chest, legs and arms. The results are displayed on the screen and interpreted by your doctor.
  • Echocardiogram: Echocardiograms use ultrasound to take detailed pictures of your heart.
  • Coronary angiography: A Coronary angiography checks blood flow through your coronary arteries. A thin tube, called a catheter, is inserted through the groin or artery to the arm and to the heart.
  • Exercise stress test: The stress test examines how exercise affects your heart. You may be asked to pedal an exercise bike or walk on a treadmill.
  • Nuclear stress test: The nuclear stress test checks blood flow to the heart. This test is usually done at rest and exercise.

Prevention and Risk Factors

A number of factors increase the risk of hypertensive heart disease. These risk factors include:

  • Age: Hypertension is more common in people over 60 years. Blood pressure can increase steadily with age because the arteries become harder and narrower when plaque is formed.
  • Ethnicity: Some ethnic groups are more susceptible to hypertensive heart disease than others. For example, African-Americans are at higher risk than other ethnic groups.
  • Size and weight: Obesity or overweight is the main risk factors.
  • Alcohol and tobacco consumption: Regular consumption of alcohol or tobacco in large quantities can increase blood pressure.
  • Gender: According to a 2018 survey, men have a higher risk of developing high blood pressure than women. However, this only happens when menopause has not been reached.
  • Existing health conditions: cardiovascular disease, diabetes, chronic kidney disease and high cholesterol can cause hypertensive heart disease, especially as we get older.
  • Inactive lifestyle
  • High salt and high-fat diet
  • Low potassium intake
  • Poorly managed stress and a family history of high blood pressure can also contribute to the risk of hypertension.

Monitoring and preventing your blood pressure from increasing is one of the most important ways to prevent hypertensive heart disease. Lowering blood pressure and cholesterol through eating healthy and monitoring stress levels is the best way to prevent heart problems.

Maintaining a healthy weight, getting enough sleep and exercising regularly are common lifestyle recommendations. Also, talk to your doctor about ways to improve your overall health.

Complications

Long-term hypertension can cause complications from arteriosclerosis, where plaque forms on the walls of blood vessels and causes narrowing of the arteries.

This narrowing worsens high blood pressure because the heart has to pump harder to circulate blood.

Arteriosclerosis associated with hypertension can cause:

  • Heart failure and heart attack
  • Abnormal aneurysm or bulge in the artery wall that can break
  • Kidney failure
  • Stroke
  • Amputation
  • Hypertensive retinopathies in the eye, which can cause blindness.

Monitoring blood pressure regularly can help people avoid these more serious complications.

Treatment of Hypertension

Treatment for hypertensive heart disease depends on the severity of your condition, your age, and your medical history. To treat hypertension, your doctor must treat high blood pressure which causes it. He will treat it with various drugs, including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, and vasodilators.

Lifestyle adjustments are the standard initial treatment for hypertensive heart disease. Here are a few recommendations:

Medication

Medications help your heart in various ways. The main goal is to prevent blood clots, improve blood circulation and reduce cholesterol. Examples of common medicines for heart disease are:

  • Water pills that help lower blood pressure
  • Nitrates are used to treat chest pain
  • Statins are used to treat high cholesterol
  • Calcium channel blockers and ACE inhibitors that help lower blood pressure
  • Aspirin to prevent the formation of blood clots.

It is important that you take all medications exactly as prescribed. The choice of medication depends on the patient and any underlying medical conditions they may experience.

Surgery and Implementation

In more critical cases, surgery may be needed to increase blood flow to your heart. If you need help regulating your heart rate or rhythm, your doctor can implant a Pacemaker (a battery-powered device) into your chest. The device creates electrical stimulation that contracts the heart muscle. Pacemaker implants are important and useful if the electrical activity of the heart muscle is too slow or absent.

Implantable Cardioverter Defibrillators (ICDs) are implantable devices for the treatment of serious and life-threatening arrhythmias.

Coronary Artery Bypass Graft (CABG) surgery treats blocked coronary arteries. This only happens in severe coronary artery disease. A heart transplant or other cardiac support device may be needed if your condition is very severe.

The DASH Diet

The U.S. National Heart, Lung, and Blood Institute (NHLBI) recommend the “Dietary Approaches to Stop Hypertension” (DASH) diet for people with high blood pressure. It is a flexible and balanced eating plan that helps create a heart-healthy eating style for life.

The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:

  • Eating vegetables, fruits, and whole grains
  • Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
  • Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
  • Limiting sugar-sweetened beverages and sweets.

Based on these recommendations, the following table shows examples of daily and weekly servings that meet DASH eating plan targets for a 2,000-calorie-a-day diet.

Food Group
Grains
Daily Servings6–8
Meats, poultry, and fish
Daily Servings6 or less
Vegetables
Daily Servings4–5
Fruit
Daily Servings4–5
Low-fat or fat-free dairy products
Daily Servings2–3
Fats and oils
Daily Servings2–3
Sodium
Daily Servings2,300 mg*
 
Daily ServingsWeekly Servings
Nuts, seeds, dry beans, and peas
Daily Servings4–5
Sweets
Daily Servings5 or less

Your doctor may also advise you to make lifestyle changes, including:

  • Diet: In heart failure, you must reduce your daily sodium intake to 1500 mg or 2 g or less per day, eat foods high in fibre and potassium, and limit your total daily calories to lose weight. It is also necessary to limit your food intake, which contains refined sugars, trans fats and cholesterol.
  • Regular Exercise: It is recommended that everyone, including hypertensive patients, exercises at least 150 minutes in moderate intensity, aerobic exercise every week, or 75 minutes every week in high-intensity exercise. People must exercise at least 5 days a week. Examples of suitable activities include hiking, jogging, biking or swimming.
  • Weight monitoring: This includes daily weight loss, increasing your activity level (recommended by your doctor), resting more often, and planning your activities.
  • Reducing Stress: Avoiding or learning to deal with stress can help a person control his blood pressure. Meditation, hot tubs, yoga, and long walks are relaxation techniques that can help reduce stress. People should avoid taking alcohol, drugs, tobacco, and junk food to deal with stress because this can cause high blood pressure and complications of hypertensive heart disease. Smoking can increase blood pressure. Avoiding or stopping smoking reduces the risk of high blood pressure, serious heart conditions, and other health problems.
  • Avoid tobacco and alcohol
  • Frequent Medical checkup: During the follow-up period, your doctor will ensure that you are healthy and that your heart condition does not get worse.

Recovery from hypertensive heart disease depends on the right conditions and their severity. Lifestyle changes can keep the situation from worsening in some cases. In severe cases, treatment and surgery may not be able to control the disease effectively.

References

  • O’Connor CM, Rogers JG. Heart failure: pathophysiology and diagnosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 58.
  • Siu AL, US Preventive Services Task Force. Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778-786. PMID: 26458123 www.ncbi.nlm.nih.gov/pubmed/26458123.
  • Mayo Clinic Staff. (2015, June 6). Left ventricular hypertrophy: Complications mayoclinic.com/health/left-ventricular-hypertrophy/DS00680/DSECTION=complications
  • Victor RG. Arterial hypertension. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 67.
  • Goldberger, Z., Lampert, R. (2006, February 15). Implantable cardioverter-defibrillators: Expanding indications and technologies. JAMA295(7), 809-818 jama.jamanetwork.com/article.aspx?articleid=202355
  • Victor RG. Systemic hypertension mechanisms and diagnosis. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 46.
  • Heart disease facts. (2015, August 10) cdc.gov/heartdisease/facts.htm
  • Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248. PMID: 29146535 www.ncbi.nlm.nih.gov/pubmed/29146535.
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