Hypertensive heart disease explained

Hypertensive heart disease

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]

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.

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.

Diagnosis

Stages of elevated BP and hypertension[7]
Category Systolic BP (mm Hg) Diastolic BP (mm Hg)
Normal < 120 < 80
Elevated 120–129 and <80
Stage I 130–139 or80–89
Stage II at least 140 or at least 90

Differential diagnosis

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

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. Drug treatment may also be needed to control the hypertension and reduce the risk of cardiovascular disease, 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:

Treatment

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

Epidemiology

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

Sex differences

There are more women than men with hypertension,[18] and, although men develop hypertension earlier in life,[19] hypertension in women is less well controlled.[20] [21] 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. 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 and that treatment for heart failure may be less effective in women.[22]

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

Notes and References

  1. vanc . Alegría-Ezquerra . Eduardo . González-Juanatey . José R. . González-Maqueda . Isidoro . Hypertensive heart disease: a proposed clinical classification . es. . 59 . 4 . 398–9 . April 2006 . 16709396 . 10.1016/S1885-5857(06)60781-0 . 29897347 .
  2. vanc . Lip . G. Y. . Felmeden . D. C. . Li-Saw-Hee . F. L. . Beevers . D. G. . Hypertensive heart disease. A complex syndrome or a hypertensive 'cardiomyopathy'? . . 21 . 20 . 1653–65 . October 2000 . 11032692 . 10.1053/euhj.2000.2339 . free .
  3. Gonzalez-Maqueda . I . Alegria-Ezquerra . Eduardo . Gonzalez-Juanatey . Jose Ramon . 2009 . Working group of the Spanish Society of Cardiology . Hypertensive heart disease: a new clinical classification (VIA) . e-Journal of the European Society of Cardiology Council for Cardiology Practice . 7 . 20 . ePub .
  4. 17 December 2014. 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. 10.1016/S0140-6736(14)61682-2. 4340604. 25530442.
  5. vanc . Grossman . E. . Messerli . F. H. . Diabetic and hypertensive heart disease . . 125 . 4 . 304–310 . August 1996 . 8678395 . 10.7326/0003-4819-125-4-199608150-00009. 38947800 .
  6. Kaye. D. M.. March 2009. Heart failure with normal left ventricular ejection fraction. Journal of the American College of Cardiology. 53. 11. 905–918. 10.1016/j.jacc.2008.12.007. 19281919. vanc. Maeder. M. T..
  7. 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)) . The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report . . May 21, 2003 . 289 . 19 . 2560–2572 . 12748199 . 17 February 2013 . 10.1001/jama.289.19.2560 .
  8. Web site: Hypertensive heart disease. Medline Plus. 17 February 2013.
  9. vanc . Hunt . Sharon Ann . Abraham . William T. . Chin . Marshall H. . Arthur M. . Feldman . Gary S. . Francis . Theodore G. . Ganiats . Mariell . Jessup . Marvin A. . Konstam . Donna M. . Mancini . Keith . Michl . John A. . Oates . Peter S. . Rahko . Marc A. . Silver . Lynne Warner . Stevenson . Clyde W. . Yancy . 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation . . 119 . 14 . e391–479 . April 2009 . 19324966 . 10.1161/CIRCULATIONAHA.109.192065 .
  10. vanc . Fuster . Valentin . Rydén . Lars E. . Cannom . Davis S. . Harry J. . Crijns . Anne B. . Curtis . Kenneth A. . Ellenbogen . Jonathan L. . Halperin . G. Neal . Kay . Jean-Yves . Le Huezey . James E. . Lowe . S. Bertil . Olsson . Eric N. . Prystowsky . Juan Luis . Tamargo . L. Samuel . Wann . 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 . . 57 . 11 . e101–98 . March 2011 . 21392637 . 10.1016/j.jacc.2010.09.013 . free .
  11. vanc . White . William B. . Cardiovascular risk, hypertension, and NSAIDs . . 9 . 1 . 36–43 . April 2007 . 17437665 . 10.1007/s11926-007-0020-3 . 31212856 .
  12. vanc . Ackman . M. L. . Campbell . J. B. . Buzak . K. A. . Tsuyuki . R. T. . Montague . T. J. . Teo . K. K. . Use of nonprescription medications by patients with congestive heart failure . . 33 . 6 . 674–679 . June 1999 . 10410177 . 10.1345/aph.18283 . 43285809 .
  13. Web site: Riaz. Kamran. Hypertensive Heart Disease. Medscape Reference. 17 February 2013.
  14. vanc . Kearney . Patricia M. . Whelton . Megan . Reynolds . Kristi . Muntner . Paul . Whelton . Paul K. . He . Jiang . Global burden of hypertension: analysis of worldwide data . . 365 . 9455 . 217–223 . 2005 . 15652604 . 10.1016/S0140-6736(05)17741-1 . 7244386 .
  15. vanc . Kannel . W. B. . Cobb . J. . Left ventricular hypertrophy and mortality—results from the Framingham Study . . 81 . 4–5 . 291–298 . 1992 . 1301257 . 10.1159/000175819 .
  16. vanc . Yamasaki . Naohito . Kitaoka . Hiroaki . Matsumura . Yoshihisa . Furuno . Takashi . Nishinaga . Masanori . Doi . Yoshinori . Heart failure in the elderly . . 42 . 5 . 383–388 . May 2003 . 12793706 . 10.2169/internalmedicine.42.383 . free .
  17. Book: World Health Organization . The Global Burden of Disease: 2004 Update . World Health Organization . Geneva . 2008 . 978-92-4-156371-0 .
  18. 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 . 10.1097/00004872-200401000-00003 . 15106785 . 24840738 .
  19. vanc . Rabi . Doreen M. . Khan . Nadia . Vallée . Michel . Hladunewich . Michelle A. . Tobe . Sheldon W. . Pilote . Louise . Reporting on sex-based analysis in clinical trials of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker efficacy . . 24 . 6 . 491–496 . June 2008 . 18548147 . 2643194 . 10.1016/S0828-282X(08)70624-X .
  20. vanc . Lloyd-Jones . Donald M. . Evans . Jane C. . Levy . Daniel . Hypertension in adults across the age spectrum: current outcomes and control in the community . . 294 . 4 . 466–472 . July 2005 . 16046653 . 10.1001/jama.294.4.466 .
  21. vanc . Sylvia . Wassertheil-Smoller . Sylvia Wassertheil-Smoller . Garnet . Anderson . Bruce M. . Psaty . Henry R. . Black . JoAnn . Manson . Nathan . Wong . Jon . Francis . Richard . Grimm . Theodore . Kotchen . Robert . Langer . Norman . Lasser . Hypertension and its treatment in postmenopausal women: baseline data from the Women's Health Initiative . . 36 . 5 . 780–789 . November 2000 . 11082143 . 10.1161/01.HYP.36.5.780 . free .
  22. vanc . Anh L. . Bui . Tamara B. . Horwich . Gregg C. . Fonarow . Epidemiology and risk profile of heart failure . . 8 . 1 . 30–41 . January 2011 . 21060326 . 3033496 . 10.1038/nrcardio.2010.165 .
  23. vanc . Keith C. . Ferdinand . Elijah . Sounders . 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 . January 2006 . 16415637 . 10.1111/j.1524-6175.2006.05295.x . 8109309 . 11034242 . free .
  24. vanc . Laura R. . Loehr . Wayne D. . Rosamond . Patricia P. . Chang . Aaron R. . Folsom . Lloyd E. . Chambless . Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study) . . 101 . 7 . 1016–1022 . April 2008 . 18359324 . 10.1016/j.amjcard.2007.11.061 .
  25. vanc . Donald . Lloyd-Jones . Robert . Adams . Mercedes . Carnethon . Giovanni . De Simone . T. Bruce . Ferguson . Katherine . Flegal . Earl . Ford . Karen . Furie . Alan . Go . Kurt . Greenlund . Nancy . Haase . Susan . Hailpern . Michael . Ho . Virginia . Howard . Brett . Kissela . Steven . Kittner . Daniel . Lackland . Lynda . Lisabeth . Ariane . Marelli . Mary . McDermott . James . Meigs . Dariush . Mozaffarian . Graham . Nichol . Christopher . O'Donnell . Veronique . Roger . Wayne . Rosamond . Ralph . Sacco . Paul . Sorlie . Randall . Stafford . Julia . Steinberger . Thomas . Thom . Sylvia . Wasserthiel-Smoller . Nathan . Wong . Judith . Wylie-Rosett . Yuling . Hong . Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee . . 119 . 3 . e21–181 . January 2009 . 19075105 . 10.1161/CIRCULATIONAHA.108.191261 . free .

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Hypertensive heart disease".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.