Hypertensive heart disease
|Hypertensive heart disease|
|Classification and external resources|
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.
- 1 Symptoms and signs
- 2 Stages
- 3 Associated conditions (potential complications)
- 4 Differential diagnosis
- 5 Treatment
- 6 Epidemiology
- 7 References
- 8 External links
Symptoms and signs
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:
- Irregular pulse or palpitations
- Swelling of feet and ankles
- Weight gain
- 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.
Stages of Elevated BP and Hypertension According to The Seventh Report of the Joint National Committee (JNC7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
|Category||Systolic BP (mm Hg)||Diastolic BP (mm Hg)|
|Optimal||< 120||< 80|
Associated conditions (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), often termed diastolic heart failure
- Atrial fibrillation, other cardiac arrhythmias and sudden cardiac death
Other conditions can share features with hypertensive heart disease and need to be considered in the differential diagnosis. For example:
- Coronary artery disease or ischemic heart disease due to atherosclerosis
- Hypertrophic cardiomyopathy
- Left ventricular hypertrophy in athletes
- Congestive heart failure or heart failure with normal ejection fraction due to other causes
- Atrial fibrillation or other disorders of cardiac rhythm due to other causes
- Sleep apnea
The medical care of patients with hypertensive heart disease falls under 2 categories—
- Treatment of the elevated BP
- Prevention and treatment of hypertensive heart disease.
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.
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.
Blood Pressure Goals
According to JNC 7, BP goals should be as follows :
- Less than 140/90mm Hg in patients with uncomplicated hypertension
- Less than 130/85mm Hg in patients with diabetes and those with renal disease with less than 1g/24-hour proteinuria
- Less than 125/75mm Hg in patients with renal disease and more than 1 g/24-hour proteinuria
Hypertension or high blood pressure affects at least 1 billion people worldwide. 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, 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. In addition, hypertension precedes heart failure in 90% of cases, and the majority of heart failure in the elderly may be attributable to hypertension. 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. A world map shows the estimated disability-adjusted life years per 100,000 inhabitants lost due to hypertensive heart disease in 2004.
Gender differences in hypertensive heart disease
There are more women than men with hypertension, and, although men develop hypertension earlier in life, hypertension in women is less well controlled. 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.
Ethnic disparities in hypertensive heart disease
Studies in the USA indicate that a disproportionate number of African Americans have hypertension compared with non-Hispanic whites and Mexican Americans, and that they suffer a greater burden of hypertensive heart disease. 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. Worryingly, recent data suggests that rates of hypertension are increasing more rapidly in African Americans than other ethnic groups. 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.
- Alegría-Ezquerra, E; González-Juanatey, JR; González-Maqueda, I (April 2006). "Hypertensive heart disease: a proposed clinical classification". Revista Española de Cardiología (in Spanish; Castilian) 59 (4): 398–9. doi:10.1016/S1885-5857(06)60781-0. PMID 16709396.
- 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.
- 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.
- 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". JAMA 289 (19): 2560–2572. doi:10.1001/jama.289.19.2560. PMID 12748199. Retrieved 17 February 2013.
- 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.
- Riaz, Kamran. "Hypertensive Heart Disease". Medscape Reference. Retrieved 17 February 2013.
- "Hypertensive heart disease". Medline Plus. Retrieved 17 February 2013.
- Hunt, SA; Abraham, WT; Chin, MH; Feldman, AM; Francis, GS; Ganiats, TG; Jessup, M; Konstam, MA; Mancini, DM; Michl, K; Oates, JA; Rahko, PS; Silver, MA; Stevenson, LW; Yancy, CW (April 2009). "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". Circulation 119 (14): e391–479. doi:10.1161/CIRCULATIONAHA.109.192065. PMID 19324966.
- Fuster, V; Rydén, LE; Cannom, DS; Crijns, HJ; Curtis, AB; Ellenbogen, KA; Halperin, JL; Kay, GN; Le Huezey, J; 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.
- White, WB (April 2007). "Cardiovascular risk, hypertension, and NSAIDs". Current Rheumatology Reports 9 (1): 36–43. doi:10.1007/s11926-007-0020-3. PMID 17437665.
- 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.
- "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov 11, 2009.
- 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.
- 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.
- 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.
- World Health Organization (2008). The Global Burden of Disease: 2004 Update. Geneva: World Health Organization. ISBN 92-4-156371-0.
- Anastos, K; Charney, P; Charon, RA; Cohen, E; Jones, CY; Marte, C; Swiderski, DM; Wheat, ME; Williams, S (August 1991). "Hypertension in women: what is really known? The Women's Caucus, Working Group on Women's Health of the Society of General Internal Medicine". Annals of Internal Medicine 115 (4): 287–293. doi:10.7326/0003-4819-115-4-287. PMID 1854113.
- 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.
- 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.
- 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.
- 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.
- 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. PMID 16415637.
- 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.
- 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.