Hypertensive Heart Disease
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:
• 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.
• 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
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.