Hypertensive heart disease includes a number of high blood pressure complications that affect the heart. Although there are several definitions of hypertensive heart disease in medical literature, this term is most widely used in the context of the International Classification coding category (ICD). Definitions include heart failure and other cardiovascular complications of hypertension when a causal relationship between heart disease and hypertension is expressed or implied on death certificates. In 2013 hypertensive heart disease resulted in 1.07 million deaths compared with 630,000 deaths in 1990.
According to ICD-10, hypertensive heart disease (I11), and its subcategory: hypertensive heart disease with heart failure (I11.0) and hypertensive heart disease without heart failure (I11.9) are distinguished from chronic rheumatic heart disease (I05-I09) other forms of heart disease (I30-I52) and ischemic heart disease (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.
Video Hypertensive heart disease
Signs and symptoms
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 heart enlargement (left ventricular hypertrophy) is usually asymptomatic.
Symptoms, signs and consequences of congestive heart failure may include:
- Fatigue
- Irregular pulse or palpitations
- Swollen feet and ankles
- Weight
- Nausea
- Shortness of breath
- Difficulty sleeping in bed (orthopnea)
- Bloated and abdominal pain
- Greater need to urinate at night
- An enlarged heart (cardiomegaly)
- Left ventricular hypertrophy and left ventricular remodeling
- Decrease in coronary flow reserve and myocardial ischemia silent
- Coronary heart disease and accelerate atherosclerosis
- Heart Failure With Normal Left Ventricular Ejection Faction (HFNEF), often called diastolic heart failure
- Atrial fibrillation, other cardiac arrhythmias, or sudden cardiac death
Heart failure can develop slowly over time or patients may present acute with acute heart failure or acute decompensated heart failure and pulmonary edema due to sudden failure of heart pump function. Sudden failure may be triggered by a variety of causes, including myocardial ischaemia, elevated blood pressure, or cardiac arrhythmias.
Maps Hypertensive heart disease
Diagnosis
Differential diagnosis
Other conditions may share features with hypertensive heart disease and need to be considered in the differential diagnosis. As an example:
- Coronary artery disease or ischemic heart disease due to atherosclerosis
- Hypertrophic cardiomyopathy
- Left ventricular hypertrophy in athletes
- Heart failure or congestive heart failure with normal ejection fraction due to other causes
- Atrial fibrillation or other heart rhythm disturbance due to other causes
- Sleep apnea
Prevention
Since there are no symptoms with high blood pressure, people may experience the condition without realizing 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 modification, including dietary advice, weight loss promotion and regular aerobic exercise, moderation of alcohol intake and smoking cessation. Drug treatment is also needed to control hypertension and reduce the risk of cardiovascular disease, manage heart failure, or control heart arrhythmias. Patients with hypertensive heart disease should avoid taking over non-steroidal anti-inflammatory drugs (NSAIDs), or cough suppressants, and decongestants containing sympathomimetics, unless advised by their physicians as this may aggravate hypertension and heart failure.
Goal blood pressure
According to JNC 7, BP's objectives 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 proteinuria less than 1 g/24 h
- Less than 125/75mm Hg in patients with kidney disease and more than 1 g/24 h proteinuria
Treatment
The medical care of patients with hypertensive heart disease is under 2 categories--
- Treatment of hypertension
- Prevention (and, if any, treatment) of heart failure or other cardiovascular diseases Epidemiology
Hypertension or high blood pressure affects at least 4 billion people worldwide. Hypertensive heart disease is just one of several diseases caused by high blood pressure. Other diseases caused by high blood pressure include ischemic heart disease, stroke, peripheral artery disease, aneurysms and kidney disease. Hypertension increases the risk of heart failure by two or threefold and may account 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 due to hypertension. Hypertensive heart disease is estimated to be responsible for 1.0 million deaths worldwide in 2004 (or about 1.7% of all deaths globally), and ranked 13th in the leading cause of global mortality for all ages. The world map shows the estimated year of disability survival per 100,000 population lost due to hypertensive heart disease in 2004.
Gender differences
There are more women than men with hypertension, and, although males develop hypertension early in life, hypertension in women is poorly 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 in men. Until recently women were underrepresented 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 differences
Studies in the US show that the number of disproportionate African Americans has hypertension compared with non-Hispanic and Mexican American whites, and that they suffer a greater burden of hypertensive heart disease. Heart failure is more common in people of African American ethnicity, death rates from heart failure are also consistently higher than in white patients, and develop at an earlier age. Worryingly, recent data indicate that rates of hypertension are rising more rapidly in African Americans than in other ethnic groups. Excess high blood pressure and its consequences in African Americans tend to contribute to their shorter life expectancy compared to white Americans.
References
External links
Source of the article : Wikipedia
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