High blood pressure increases the workload of the heart, and over time, this can cause thickening of the heart muscle and the symptoms of hypertensive heart disease.

As the heart continues to pump against elevated pressure in the blood vessels, the left ventricle becomes enlarged, cardiac output (the amount of blood pumped by the heart each minute) goes down, and without treatment, symptoms of congestive heart failure may develop.

High blood pressure is the most common risk factor for heart disease and stroke. For example, it can cause ischemic heart disease (decreased blood to the heart muscle that results in anginal chest pain and heart attacks) because of the increased supply of oxygen needed by the thicker heart muscle.

High blood pressure also contributes to the thickening of the blood vessel walls, which in turn may aggravate atherosclerosis (characerized by increased cholesterol deposits in the blood vessels). This also increases the risk of heart attacks and stroke.

Hypertensive heart disease is the leading cause of illness and death from hypertension. It affects approximately 7 out of 1,000 people.

High blood pressure is known as a silent killer because by the time symptoms of hypertensive heart disease appear, the condition can be life-threatening. Congestive heart failure is one possible result of hypertensive heart disease. Symptoms of congestive heart failure include:

• Shortness of breath, especially with activity
• Waking at night short of breath
• Need to sleep with the head elevated to avoid shortness of breath
• Rapid or irregular pulse
• Sensation of feeling the heart beat (palpitations)
• Cough, which may produce frothy or blood-tinged mucus
• Fatigue, weakness, faintness
• Swelling of the feet and ankles
• Increased frequency of urination at night

Ischemic heart disease is another possible result of hypertensive heart disease. Symptoms include:

• Chest pain, pressure-type, particularly with exertion
• Chest pain associated with:
  • Nausea
  • Sweating
  • Dizziness
  • Shortness of breath

A third possible result is hypertrophic cardiomyopathy.

Signs of heart disease are found on physical examination. The blood pressure is elevated. Enlargement of the heart may be noted. Listening to the chest with a stethoscope may reveal fluid in the lungs or abnormal heart sounds. Late in the history of the condition, there may be signs of heart failure including pulmonary (lung) congestion.

An ECG may be abnormal, showing an enlarged heart, an irregular heart beat, and/or evidence of ischemia (lack of oxygen to the heart muscle).

Enlargement of the heart or decreased heart functioning may be seen on:

• An echocardiogram
• A chest X-ray
• A chest CT scan (rarely performed for this diagnosis)
• A coronary angiogram

The goals of treatment are to reduce blood pressure and control the heart disease. Treatment of heart disease depends on which condition is present (acute myocardial infarction, angina, heart failure, and so on).

Common medications include diuretics, potassium replacements, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists, and direct vasodilators. Diazoxide and nitroprusside are intravenous medications that may be prescribed if hypertension is extremely severe and intensive care is necessary.

Blood pressure should be checked at regular intervals (as recommended by the health care provider) to monitor the condition. Frequent blood pressure measurements performed at home are often recommended for patients who have difficult-to-control high blood pressure. Diabetes, hyperlipidemia, and other conditions that increase the risk of heart disease should be carefully controlled.

In addition to medications, recommended lifestyle changes include weight loss, exercise, and dietary adjustments. Recent dietary recommendations include increasing fruits, vegetables, and low-fat dairy products. Whole grains, poultry, and fish are also generally recommended.

Older patients may benefit from reducing salt intake. If you smoke, stop smoking -- cigarettes are a major cause of hypertension and related heart disease. Reducing excessive alcohol consumption can also help.

The risk for complications depends heavily on the extent of left ventricle enlargement (hypertrophy) -- the larger it is, the greater the chance of complications. Treatment of hypertension may reduce the amount of left ventricle damage.

Several studies have shown that certain medications (such as the ACE inhibitors, beta-blockers, and the diuretic spironolactone) can reverse left ventricular hypertrophy and prolong survival in patients with heart failure from hypertensive heart disease.

Nonetheless, this is a serious disease which carries the risk of sudden death.

• heart failure
• arrhythmias
• myocardial infarction (tissue death)
• angina
• sudden death

Call your health care provider if hypertension has been diagnosed and symptoms develop.

Treat any known hypertension. Do not stop or change treatment except as advised by the health care provider. Monitor blood pressure as advised.