Definition
Hypertensive heart disease is characterized by a firmly continuous high blood pressure in which the force of blood against the artery walls is too high. Continuous hypertension causes structural and functional abnormalities of the heart. This can also cause damage to the ventricular and arterial myocardium as well as the epicardium and intramural coronary arteries. As a result, other heart diseases can occur like myocardial ischemia, arterial fibrillation, and congestive heart failure.
Epidemiology
Hypertension or high blood pressure affects at least 4 billion people worldwide. 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, stroke, peripheral arterial disease, aneurysms and kidney disease.
Hypertension increases the risk of heart failure by two or three-folds and probably accounts for about 25% of all cases of heart failure. In addition, hypertension precedes heart failure in 90% of cases, and the majority of heart failure in the elderly may be attributable to hypertension.
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.
Types
Coronary Heart Disease (CHD):
Coronary heart disease (CHD) in general, the heart problems caused due to high blood pressure are related to the heart’s arteries and muscles. It is called coronary artery disease. It can put you at risk for a heart attack from a blood clot that gets stuck in one of the narrowed arteries and cuts off blood flow to your heart.
High blood pressure makes pumping of blood to heart difficult. Like other muscles in your body, regular hard work causes your heart muscles to thicken and grow and this alters the way, the heart functions. The main pumping functions in the chamber of the heart happen usually by changing, the left ventricle. This condition is known as left ventricular hypertrophy (LVH).
CHD can cause LVH and they are directly proportional to each other. When you have CHD, your heart must work harder. If LVH enlarges your heart, it compacts the coronary arteries.
Risk factors
Some of the risk factors that are
- Non-modifiable
- Male sex; it is said that eostrogen produced in women confers a beneficial effect on them. However, he is lost after menopause or in DM.
- Black race
- Positive family history
- Modifiable
- Diabetes
- Phaeochromocytoma
- Smoking
- Excessive alcohol
- Hyperlipedaemia
- Sedentary lifestyle
- Obese
Causes
- High blood pressure means the pressure inside the blood vessels (called arteries) is too high. As the heart pumps against this pressure, it must work harder. Over time, this causes the heart muscle to thicken.
- Because there are often no symptoms with high blood pressure, people can have a problem without knowing it. Symptoms most often do not occur until after many years of poor blood pressure control, when damage to the heart has occurred.
- Without treatment of high blood pressure, symptoms of heart failure may develop. Sometimes, the muscle can be so thick that it does not get enough oxygen. This can cause angina (chest pain).
- High blood pressure also leads to thickening of the blood vessel walls. When combined with cholesterol deposits in the blood vessels, the risk of heart attack and stroke increases.
- Hypertensive heart disease is the leading cause of illness and death from high blood pressure.
Symptoms
There are a few symptoms of hypertensive heart disease such as :
- Fatigue
- Weakness
- Chest Pain
- Leg or ankle swelling
- Pain in the neck, shoulder, back, and arm
- A cough
- Loss of appetite
- Tightness or pressure in the chest
- Nausea
- Indigestion
- Bloating and abdominal pain
Complications
Both CHD and LVH can lead to:
Heart failure: your heart is unable to pump enough blood to the rest of your body
Arrhythmia: your heart beats abnormally
Ischemic heart disease: your heart doesn’t get enough oxygen
Heart attack: blood flow to the heart is interrupted and the heart muscle dies from lack of oxygen
Sudden cardiac arrest: your heart suddenly stops working, you stop breathing, and you lose consciousness
Stroke and sudden death
Diagnosis and test
To begin with, the treating physician will take a detailed history to include family history and social history. The physician will then conduct a physical examination to check the blood pressure and if found chronically hypertensive then the following tests will be conducted:
Electrocardiogram: This test shows the heartbeat in the form of electrical impulses. This test can show whether there is any abnormality in the rhythm of the heart and whether the heart is functioning normally.
Echocardiogram: This test makes use of ultrasound waves to look at the functioning of the heart. This test can accurately identify any abnormality of the functioning of the heart.
Chest X-ray: This can reveal whether there is any enlargement of the heart or not which can rule in or rule out cardiomegaly as a cause of the heart murmur. Apart from these tests a CT scan or an MRI will also be obtained which can accurately detect the presence of a cardiac problem.
Coronary Angiography: This test checks the blood flow to and from the heart examines. Any abnormality in flow of blood in the heart can be confirmed through this test.
Treadmill Stress Test: This test is conducted to find out the exercise tolerance of the patient and how much distance the patient can cover on the treadmill before the patient starts having symptoms. This is quite helpful in confirming the diagnosis and formulating a treatment plan.
Treatment and medications
Treatment of heart disease of involves a mix of lifestyle changes and medications. It all depends on what sort of condition the victim is in and the individual problems that are occurring. Some of the medications prescribed are:
- Angiotensin-converting enzyme (ACE) inhibitors
- Vasodilators
- Calcium channel blockers
- Diuretics
- Angiotensin II receptor antagonists
- Beta-blockers
If the symptoms of heart disease are bad enough, the doctor may want to do corrective surgery. This could be surgeries such as a coronary bypass, repair of the heart valves, or surgeries to repair damaged or malformed blood vessels.
Prevention
Diagnosing high blood pressure early can help prevent heart disease, stroke, eye problems, and chronic kidney disease.
All adults over the age of 18 should have their blood pressure checked every year. More frequent measurement may be needed for those with a history of high blood pressure readings or those with risk factors for high blood pressure.
Guidelines can change as new information becomes available, Therefore, your health care provider may recommend more frequent screenings based on your blood pressure levels and other health conditions.
If your blood pressure is high, you need to lower it and keep it under control.
- Do not stop or change high blood pressure medicines without talking to your provider.
- Carefully control diabetes and high cholesterol.
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