Hypertension: Hypertensive Heart Disease

 

Hypertensive heart disease is the No. 1 cause of death associated with hypertension and is actually a group of disorders that include heart failure, ischemic heart disease, and left ventricular hypertrophy (excessive thickening of the heart muscle).

What Is Heart Failure

Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal or the heart has become less elastic. With heart failure, blood moves through the heart and body less effectively and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart respond by stretching to hold more blood to pump through the body. This helps to keep the blood moving, but in time, the heart muscle walls weaken and are unable to pump as strongly. As a result, the kidneys often respond by causing the body to retain fluid (water) and sodium. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.

Hypertension brings on heart failure by causing coronary artery disease and left ventricular hypertophy. Symptoms of heart failure include:

• Shortness of breath
• Swelling in the feet, ankles, or abdomen
• Difficulty sleeping flat in bed
• Bloating
• Irregular pulse
• Nausea
• Fatigue
• Greater need to urinate at night

What Is Ischemic Heart Disease

Hypertension can also cause ischemic heart disease. This means that the heart muscle  isn't getting enough blood. Ischemic heart disease is usually the result of atherosclerosis or hardening of the arteries (coronary artery disease), which impedes the blood flow. This can progress to a heart attack. Symptoms of ischemic heart disease may include:

• Chest pain which may radiate (travel) to the arms, back, neck, or jaw
• Chest pain with nausea, sweating, shortness of breath, and dizziness; these associated symptoms may also occur without chest pain
• Irregular pulse
• Fatigue and weakness

Any of these symptoms warrant immediate medical evaluation.

What Is Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy is a condition in which  the muscular walls of the heart are thickened. This can prevent the heart valves from functioning normally or may keep blood from flowing out of the heart. It usually occurs independently of high blood pressure.

Symptoms of hypertrophic cardiomyopathy may include:

• Chest pain
• Irregular pulse
• Rapid heartbeat
• Shortness of breath
• Fatigue, weakness
• Fainting

Learn more about hypertrophic cardiomyopathy

How Is Hypertensive Heart Disease Diagnosed

Your doctor will look for certain signs, including:

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

Your doctor may perform tests to determine if you have hypertensive heart disease, including a electrocardiogram, echocardiogram, cardiac stress test, chest X-ray, and coronary angiogram.

How Is Hypertensive Heart Disease Treated

In order to treat hypertensive heart disease, your doctor has to treat the hypertension that is causing it. He or she will treat it with a variety of medications, including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, angiotensin II receptor blockers, and vasodilators.

In addition, your doctor may advise you to make changes to your lifestyle, including:

• Diet: If heart failure is present, lowering the total amount of sodium to 2,000 mg or 2 g or less per day; eating foods high in fiber and potassium; limiting total daily calories to lose weight if necessary; and limiting foods that contain refined sugar, saturated fats, and cholesterol.
• Monitoring your weight: This involves daily recording of weight; increasing your activity level (as recommended by your doctor); resting between activities more often; planning your activities.
• Avoiding tobacco products and alcohol
• Regular medical checkups: During follow-up visits, your doctor will make sure you are staying healthy and that your heart disease is not getting worse.

In some cases, you may need surgery to correct the heart disease. Surgeries include coronary bypass grafting (to bypass clogged heart arteries), mitral valve repair (to repair a leaky valve caused by cardiomyopathy or ischemia),  vascular surgeries (to repair defects of the blood vessels), and implantation of a left ventricular assist device (to improve pumping if you have heart failure as a bridge to heart transplantation).

Reviewed by the doctors at The Cleveland Clinic Heart Center.