Hypertensive heart disease refers to heart problems that occur because of high blood pressure that is present over a long time.

High blood pressure means the pressure inside the blood vessels (called arteries) is too high. As the heart pumps against this pressure, it must work harder. Over time, this causes the heart muscle to thicken.

Because there are often no symptoms with high blood pressure, people can have the problem without knowing it. Symptoms most often do not occur until after many years of poor blood pressure control, when damage to the heart has occurred.

Without treatment of high blood pressure, symptoms of heart failure may develop. Sometimes, the muscle can be so thick that it does not get enough oxygen. This can cause angina (chest pain).

High blood pressure also leads to thickening of the blood vessel walls. When combined with cholesterol deposits in the blood vessels, the risk of heart attack and stroke increases.

Hypertensive heart disease is the leading cause of illness and death from high blood pressure.


  • chest pain (angina)
  • tightness or pressure in the chest
  • shortness of breath
  • fatigue
  • pain in the neck, back, arms, or shoulders
  • persistent cough
  • loss of appetite
  • foot or ankle swelling


The doctor will ask you about your medical history and perform a physical exam. He will order routine blood tests and suggest one or more diagnostic tests. These include:

  • Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack or one that’s in progress.
  • In other cases, Holter monitoring may be recommended. With this type of ECG, you wear a portable monitor for 24 hours as you go about your normal activities. Certain abnormalities may indicate inadequate blood flow to your heart.
  • Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart’s pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
  • Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise.
  • Coronary angiography uses dye and special x rays to show the inside of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor find blockages that can cause a heart attack.



Lifestyle changes

Lifestyle changes can help to alleviate symptoms, slow disease progression and improve quality of life. These include:

  • Quitting smoking
  • Losing excess pounds or maintaining a healthy weight
  • Tracking daily fluid intake
  • Avoiding alcohol
  • Eating a heart-healthy diet
  • Being physically active
  • Monitoring blood pressure
  • Avoiding flu and pneumonia with vaccinations


Patients with heart failure may need to take several classes of medications, which treat different symptoms or contributing factors. These include:

  • ACE Inhibitors (captopril, enalapril)
  • Angiotensin Receptor Blockers (candesartan, losartan, valsartan)
  • Angiotensin-Receptor Neprilysin Inhibitors (sacubitril/valsartan)
  • Calcium channel blockers (amlodipine, diltiazem, nifedipine, verapamil)
  • Beta blockers (bisoprolol, metoprolol, carvedilol)
  • Diuretics (furosemide, chlorothiazide)
  • Aldosterone antagonists (spironolactone)
  • Anticoagulants (warfarin, heparin)
  • Aspirin
  • Cholesterol-lowering medications (statins)

Devices and surgical procedures

  • Implantable Cardioverter-Defibrillator (ICD) are indicated for patients with severe heart failure or serious arrhythmias (irregular heartbeats). These devices are surgically placed and deliver pacing, or an electric countershock, to the heart when a life-threatening abnormal rhythm is detected.
  • Left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that’s surgically implanted. It helps maintain the pumping ability of a heart that can’t effectively work on its own.
  • Heart transplantation is often the last resort for patients with severe, progressive heart failure that can’t be helped by medications and dietary and lifestyle changes.

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