Hypertensive heart disease

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Hypertensive heart disease
Grade 1 hypertension.jpg
Automated arm blood pressure meter showing arterial hypertension (shown a systolic blood pressure 158 mmHg, diastolic blood pressure 99 mmHg and heart rate of 80 beats per minute)
Specialty Cardiology   OOjs UI icon edit-ltr-progressive.svg

Hypertensive heart disease includes a number of complications of high blood pressure that affect the heart. While there are several definitions of hypertensive heart disease in the medical literature, [1] [2] [3] the term is most widely used in the context of the International Classification of Diseases (ICD) coding categories. The definition includes heart failure and other cardiac complications of hypertension when a causal relationship between the heart disease and hypertension is stated or implied on the death certificate. In 2013 hypertensive heart disease resulted in 1.07 million deaths as compared with 630,000 deaths in 1990. [4]

Contents

According to ICD-10, hypertensive heart disease (I11), and its subcategories: hypertensive heart disease with heart failure (I11.0) and hypertensive heart disease without heart failure (I11.9) are distinguished from chronic rheumatic heart diseases (I05-I09), other forms of heart disease (I30-I52) and ischemic heart diseases (I20-I25). However, since high blood pressure is a risk factor for atherosclerosis and ischemic heart disease, [5] death rates from hypertensive heart disease provide an incomplete measure of the burden of disease due to high blood pressure.

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.[ citation needed ]

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

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.[ citation needed ]

Diagnosis

Stages of elevated BP and hypertension [7]
CategorySystolic BP (mm Hg)Diastolic BP (mm Hg)
Normal< 120< 80
Elevated120–129 and<80
Stage I130–139 or80–89
Stage IIat least 140 orat least 90

Differential diagnosis

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

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. [8]

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. [7] Drug treatment may also be needed to control the hypertension and reduce the risk of cardiovascular disease, [7] manage the heart failure, [9] or control cardiac arrhythmias. [10] 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. [11] [12]

Blood pressure goals

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

Treatment

The medical care of patients with hypertensive heart disease falls under 2 categories— [13]

Epidemiology

Deaths due to hypertensive crisis per million persons in 2012 .mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column} .mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{} 9-54 55-64 65-78 79-92 93-113 114-141 142-173 174-217 218-317 318-1618 Hypertensive heart disease world map-Deaths per million persons-WHO2012.svg
Deaths due to hypertensive crisis per million persons in 2012
  9–54
  55–64
  65–78
  79–92
  93–113
  114–141
  142–173
  174–217
  218–317
  318–1618
Disability-adjusted life year for hypertensive heart disease per 100,000 inhabitants in 2004. no data less than 110 110-220 220-330 330-440 440-550 550-660 660-770 770-880 880-990 990-1100 1100-1600 more than 1600 Hypertensive heart disease world map - DALY - WHO2004.svg
Disability-adjusted life year for hypertensive heart disease per 100,000 inhabitants in 2004.
  no data
  less than 110
  110–220
  220–330
  330–440
  440–550
  550–660
  660–770
  770–880
  880–990
  990–1100
  1100–1600
  more than 1600

Hypertension or high blood pressure affects at least 26.4% of the world's population. [15] 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 [7] and probably accounts for about 25% of all cases of heart failure. [16] In addition, hypertension precedes heart failure in 90% of cases, [7] and the majority of heart failure in the elderly may be attributable to hypertension. [17] 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. [18] A world map shows the estimated disability-adjusted life years per 100,000 inhabitants lost due to hypertensive heart disease in 2004. [14]

Sex differences

There are more women than men with hypertension, [19] and, although men develop hypertension earlier in life, [20] hypertension in women is less well controlled. [21] [22] 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. [20] 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 [20] and that treatment for heart failure may be less effective in women. [23]

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. [24] 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. [23] [25] Recent data suggests that rates of hypertension are increasing more rapidly in African Americans than other ethnic groups. [26] 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. [24]

Related Research Articles

<span class="mw-page-title-main">Cardiology</span> Branch of medicine dealing with the heart

Cardiology is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a sub-specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.

<span class="mw-page-title-main">Coronary artery disease</span> Reduction of blood flow to the heart

Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the cardiac muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, and myocardial infarction.

<span class="mw-page-title-main">Angina</span> Chest discomfort from heart muscles

Angina, also known as angina pectoris, is chest pain or pressure, usually caused by insufficient blood flow to the heart muscle (myocardium). It is most commonly a symptom of coronary artery disease.

<span class="mw-page-title-main">Hypertension</span> Long-term high blood pressure in the arteries

Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide.

<span class="mw-page-title-main">Aortic stenosis</span> Narrowing of the exit of the hearts left ventricle

Aortic stenosis is the narrowing of the exit of the left ventricle of the heart, such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If heart failure, loss of consciousness, or heart related chest pain occur due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercising. Signs of heart failure include shortness of breath especially when lying down, at night, or with exercise, and swelling of the legs. Thickening of the valve without causing obstruction is known as aortic sclerosis.

<span class="mw-page-title-main">Heart failure</span> Failure of the heart to provide sufficient blood flow

Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to fill with and pump blood.

Hypertrophic cardiomyopathy is a condition in which muscle tissues of the heart become thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This results in the heart being less able to pump blood effectively and also may cause electrical conduction problems. Specifically, within the bundle branches that conduct impulses through the interventricular septum and into the Purkinje fibers, as these are responsible for the depolarization of contractile cells of both ventricles.

Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke, heart failure, kidney failure and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21%, and can reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used medications are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers.

<span class="mw-page-title-main">Aortic regurgitation</span> Medical condition

Aortic regurgitation (AR), also known as aortic insufficiency (AI), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. As a consequence, the cardiac muscle is forced to work harder than normal.

<span class="mw-page-title-main">Pulmonary hypertension</span> Increased blood pressure in lung arteries

Pulmonary hypertension is a condition of increased blood pressure in the arteries of the lungs. Symptoms include shortness of breath, fainting, tiredness, chest pain, swelling of the legs, and a fast heartbeat. The condition may make it difficult to exercise. Onset is typically gradual. According to the definition at the 6th World Symposium of Pulmonary Hypertension in 2018, a patient is deemed to have pulmonary hypertension if the pulmonary mean arterial pressure is greater than 20mmHg at rest, revised down from a purely arbitrary 25mmHg, and pulmonary vascular resistance (PVR) greater than 3 Wood units.

<span class="mw-page-title-main">Left ventricular hypertrophy</span> Medical condition

Left ventricular hypertrophy (LVH) is thickening of the heart muscle of the left ventricle of the heart, that is, left-sided ventricular hypertrophy and resulting increased left ventricular mass.

In cardiology, ventricular remodeling refers to changes in the size, shape, structure, and function of the heart. This can happen as a result of exercise or after injury to the heart muscle. The injury is typically due to acute myocardial infarction, but may be from a number of causes that result in increased pressure or volume, causing pressure overload or volume overload on the heart. Chronic hypertension, congenital heart disease with intracardiac shunting, and valvular heart disease may also lead to remodeling. After the insult occurs, a series of histopathological and structural changes occur in the left ventricular myocardium that lead to progressive decline in left ventricular performance. Ultimately, ventricular remodeling may result in diminished contractile (systolic) function and reduced stroke volume.

<span class="mw-page-title-main">Ventricular hypertrophy</span> Medical condition

Ventricular hypertrophy (VH) is thickening of the walls of a ventricle of the heart. Although left ventricular hypertrophy (LVH) is more common, right ventricular hypertrophy (RVH), as well as concurrent hypertrophy of both ventricles can also occur.

<span class="mw-page-title-main">Hypertensive emergency</span> Very high blood pressure and signs of organ damage

A hypertensive emergency is very high blood pressure with potentially life-threatening symptoms and signs of acute damage to one or more organ systems. It is different from a hypertensive urgency by this additional evidence for impending irreversible hypertension-mediated organ damage (HMOD). Blood pressure is often above 200/120 mmHg, however there are no universally accepted cutoff values.

<span class="mw-page-title-main">Cardiomegaly</span> Medical condition

Cardiomegaly is a medical condition in which the heart becomes enlarged. It is more commonly referred to simply as "having an enlarged heart". It is usually the result of underlying conditions that make the heart work harder, such as obesity, heart valve disease, high blood pressure (hypertension), and coronary artery disease. Cardiomyopathy is also associated with cardiomegaly.

<span class="mw-page-title-main">Right ventricular hypertrophy</span> Medical condition

Right ventricular hypertrophy (RVH) is a condition defined by an abnormal enlargement of the cardiac muscle surrounding the right ventricle. The right ventricle is one of the four chambers of the heart. It is located towards the right lower chamber of the heart and it receives Deoxygenated blood from the right upper chamber and pumps blood into the lungs.

The following outline is provided as an overview of and topical guide to cardiology, the branch of medicine dealing with disorders of the human heart. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in cardiology are called cardiologists.

<span class="mw-page-title-main">Vectorcardiography</span>

Vectorcardiography (VCG) is a method of recording the magnitude and direction of the electrical forces that are generated by the heart by means of a continuous series of vectors that form curving lines around a central point.

<span class="mw-page-title-main">Complications of hypertension</span>

Complications of hypertension are clinical outcomes that result from persistent elevation of blood pressure. Hypertension is a risk factor for all clinical manifestations of atherosclerosis since it is a risk factor for atherosclerosis itself. It is an independent predisposing factor for heart failure, coronary artery disease, stroke, kidney disease, and peripheral arterial disease. It is the most important risk factor for cardiovascular morbidity and mortality, in industrialized countries.

<span class="mw-page-title-main">Heart failure with preserved ejection fraction</span> Medical condition

Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).

References

  1. ↑ Alegría-Ezquerra E, González-Juanatey JR, González-Maqueda I (April 2006). "Hypertensive heart disease: a proposed clinical classification". Revista Española de Cardiología (in Spanish). 59 (4): 398–9. doi:10.1016/S1885-5857(06)60781-0. PMID   16709396. S2CID   29897347.
  2. ↑ Lip GY, Felmeden DC, Li-Saw-Hee FL, Beevers DG (October 2000). "Hypertensive heart disease. A complex syndrome or a hypertensive 'cardiomyopathy'?". European Heart Journal . 21 (20): 1653–65. doi: 10.1053/euhj.2000.2339 . PMID   11032692.
  3. ↑ Gonzalez-Maqueda, I; Alegria-Ezquerra, Eduardo; Gonzalez-Juanatey, Jose Ramon; Working group of the Spanish Society of Cardiology (2009). "Hypertensive heart disease: a new clinical classification (VIA)". e-Journal of the European Society of Cardiology Council for Cardiology Practice. 7 (20): ePub.
  4. ↑ "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. 385 (9963): 117–71. 17 December 2014. doi:10.1016/S0140-6736(14)61682-2. PMC   4340604 . PMID   25530442.
  5. 1 2 3 4 5 6 Grossman E, Messerli FH (August 1996). "Diabetic and hypertensive heart disease". Annals of Internal Medicine . 125 (4): 304–310. doi:10.7326/0003-4819-125-4-199608150-00009. PMID   8678395. S2CID   38947800.
  6. ↑ Maeder MT, Kaye DM (March 2009). "Heart failure with normal left ventricular ejection fraction". Journal of the American College of Cardiology . 53 (11): 905–918. doi:10.1016/j.jacc.2008.12.007. PMID   19281919.
  7. 1 2 3 4 5 6 Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ, National Heart, Lung, and Blood Institute, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee (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" (PDF). JAMA . 289 (19): 2560–2572. doi:10.1001/jama.289.19.2560. PMID   12748199 . Retrieved 17 February 2013.
  8. ↑ "Hypertensive heart disease". Medline Plus. Retrieved 17 February 2013.
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  10. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Kay GN, Le Huezey JY, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann LS (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 . 57 (11): e101–98. doi: 10.1016/j.jacc.2010.09.013 . PMID   21392637.
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  12. ↑ Ackman ML, Campbell JB, Buzak KA, Tsuyuki RT, Montague TJ, Teo KK (June 1999). "Use of nonprescription medications by patients with congestive heart failure". Annals of Pharmacotherapy . 33 (6): 674–679. doi:10.1345/aph.18283. PMID   10410177. S2CID   43285809.
  13. ↑ Riaz, Kamran. "Hypertensive Heart Disease". Medscape Reference. Retrieved 17 February 2013.
  14. 1 2 "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov 11, 2009.
  15. ↑ Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005). "Global burden of hypertension: analysis of worldwide data". The Lancet . 365 (9455): 217–223. doi:10.1016/S0140-6736(05)17741-1. PMID   15652604. S2CID   7244386.
  16. ↑ Kannel WB, Cobb J (1992). "Left ventricular hypertrophy and mortality—results from the Framingham Study". Cardiology . 81 (4–5): 291–298. doi:10.1159/000175819. PMID   1301257.
  17. ↑ Yamasaki N, Kitaoka H, Matsumura Y, Furuno T, Nishinaga M, Doi Y (May 2003). "Heart failure in the elderly". Internal Medicine . 42 (5): 383–388. doi: 10.2169/internalmedicine.42.383 . PMID   12793706.
  18. ↑ World Health Organization (2008). The Global Burden of Disease: 2004 Update. Geneva: World Health Organization. ISBN   978-92-4-156371-0.
  19. ↑ Kearney, Patricia M; Whelton, Megan; Reynolds, Kristi; Whelton, Paul K; He, Jiang (2004). "Worldwide prevalence of hypertension: a systematic review". Journal of Hypertension. 22 (1): 11–19. doi:10.1097/00004872-200401000-00003. PMID   15106785. S2CID   24840738.
  20. 1 2 3 Rabi DM, Khan N, Vallée M, Hladunewich MA, Tobe SW, Pilote L (June 2008). "Reporting on sex-based analysis in clinical trials of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker efficacy". Canadian Journal of Cardiology . 24 (6): 491–496. doi:10.1016/S0828-282X(08)70624-X. PMC   2643194 . PMID   18548147.
  21. ↑ Lloyd-Jones DM, Evans JC, Levy D (July 2005). "Hypertension in adults across the age spectrum: current outcomes and control in the community". JAMA . 294 (4): 466–472. doi:10.1001/jama.294.4.466. PMID   16046653.
  22. ↑ Wassertheil-Smoller S, Anderson G, Psaty BM, Black HR, Manson J, Wong N, Francis J, Grimm R, Kotchen T, Langer R, Lasser N (November 2000). "Hypertension and its treatment in postmenopausal women: baseline data from the Women's Health Initiative". Hypertension . 36 (5): 780–789. doi: 10.1161/01.HYP.36.5.780 . PMID   11082143.
  23. 1 2 Bui AL, Horwich TB, Fonarow GC (January 2011). "Epidemiology and risk profile of heart failure". Nature Reviews Cardiology . 8 (1): 30–41. doi:10.1038/nrcardio.2010.165. PMC   3033496 . PMID   21060326.
  24. 1 2 Ferdinand KC, Sounders E (January 2006). "Hypertension-related morbidity and mortality in African Americans—why we need to do better". Journal of Clinical Hypertension (Greenwich). 8 (1 Suppl 1): 21–30. doi: 10.1111/j.1524-6175.2006.05295.x . PMC   8109309 . PMID   16415637. S2CID   11034242.
  25. ↑ Loehr LR, Rosamond WD, Chang PP, Folsom AR, Chambless LE (April 2008). "Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study)". American Journal of Cardiology . 101 (7): 1016–1022. doi:10.1016/j.amjcard.2007.11.061. PMID   18359324.
  26. ↑ Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O'Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y (January 2009). "Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee". Circulation . 119 (3): e21–181. doi: 10.1161/CIRCULATIONAHA.108.191261 . PMID   19075105.
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