Hypertensive heart disease includes a number of complications of
systemic arterial hypertension or high blood pressure that affect the
heart. While there are several definitions of hypertensive heart disease
in the medical literature, the term is most widely used in the context
of the International Classification of Diseases (ICD) coding categories.
The definition in the Tenth Revision of the International
Classification of Diseases (ICD-10) 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. 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, 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. Symptoms and
signs of chronic heart failure can include:
• Fatigue
• Irregular pulse or palpitations
• Swelling of feet and ankles
• Weight gain
• Nausea
• Shortness of breath
• Difficulty sleeping flat in bed (orthopnea)
• Bloating and abdominal pain
• Greater need to urinate at night
• Altered mentation (in severe cases)
• An enlarged heart (cardiomegaly)
Patients can present acutely with heart failure and pulmonary edema
due to sudden failure of pump function of the heart. Acute heart failure
can be precipitated by a variety of causes including myocardial
ischemia, marked increases in blood pressure, or cardiac dysrhythmias,
especially atrial fibrillation. Alternatively heart failure can develop
insidiously over time.
Potential Complications
• Left ventricular hypertrophy and left ventricular remodeling
• Diminished coronary flow reserve and silent myocardial ischemia
• Coronary heart disease and accelerated atherosclerosis
• Congestive heart failure, including Heart Failure With Normal Left
Ventricular Ejection Fraction (HFNEF),[4] often termed diastolic heart
failure
• Atrial fibrillation, other cardiac arrhythmias and sudden cardiac death
Treatment
Treatment of hypertensive heart disease aims to normalize the elevated
blood pressure and prevent and/or treat the cardiac consequences of
hypertension. 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.
Drug treatment may also be needed to control the hypertension and
reduce the risk of cardiovascular disease, manage the heart failure, or
control cardiac arrhythmias. Patients with hypertensive heart disease
should avoid taking over the counter non-steroidal 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.