Hypertensive Heart Disease

OVERVIEW

Arterial hypertension is one of the many diseases that has gained fast-rising recognition in the society. It carries a truly terrifying burden of morbidity and mortality; evidenced not only by the annual mortality rates but also by the unrelenting efforts being put across to help improve management of the condition.

There currently exist many renowned complications of arterial hypertension(cerebro vascular accidents, Retinopathies, Renal deficits, hypertensive heart disease).

Hypertensive heart disease is gradually gaining much more recognition owing to its high prevalence in society with coexisting high mortality and morbidity rates.

DEFINITION

The term hypertensive heart disease encompasses cardiac outcomes or complications associated with the direct effect of hypertension on the heart.

CLASSIFICATIONS

Currently 3 major variants of hypertensive heart disease exist:

Heart failure, myocardial ischemia and atrial fibrillation. Either of these conditions may occur in isolation or coexist in a patient with hypertension. These are effects of hypertension that truly place a great burden on the quality of life, owing to their aggressive presentations and financial strain on the patient.

CLINICAL SIGNS

As stated above, patients with hypertensive heart disease may present to their clinicians with symptoms of any of the 3 forms of the condition.

In the event of a myocardial schemia/ infarction, chest pain usually localised to the left aspect of the chest, increased perspiration and palpitations may be the major complaints of a patient. Some may be on the more aggressive side of the spectrum presenting with sudden onset of breathlessness indicating a possible left ventricular failure.

Arrhythmias(atrial fibrillation) is although not as life-threatening as ventricular fibrillation may pave the way for heart failure(with a reduced ejection fraction). People with the condition may notice frequent skips in heartbeat which may be associated with sudden unexplained collapse.

Such patients are also at risk of recurrent cerebro vascular accidents.
Heart failure may occur directly from the effect of hypertension on the heart or may result from myocardial ischemia or atrial fibrillation. It may be associated with only the left side of the heart, the right side or both sides(biventricular). Such patients may have swollen feet and abdomen, engorged neck veins, episodic night time breathlessness.

RISK FACTORS

Some of the factors that contribute to the severity and/or rate of progress of hypertensive heart disease include coexisting risk factors; obesity, insulin resistance, high salt intake, etc.

REASONS FOR THE HIGH INCIDENCE OF MORTALITY

Indeed these conditions as shown have a deleterious effect on general well being on individuals which gets worse progressively over time with delayed medical intervention. Truly adequate treatment of hypertensive heart disease has been a challenge to this day, the fact that majority of mortalities resulting from hypertensive heart disease occur due to delayed initiation of treatment, mainly because of the reluctance of most people to present to the clinic.

This reluctance may be attributed to ignorance, fear of being branded chronically sick, resorting to other unconventional modes of treatments(primitive approaches such as herbal medications; an
approach very much common in tribal-based populations).

PROPHYLACTIC TREATMENT

Approaching hypertensive heart disease with a prophylactic mindset plays a very crucial role in reducing the risk of a vast majority of people on the path to developing the condition.

Prophylaxis is predominantly founded on adequate education and sensitization of the general public on the risks of the condition and how to avoid it; mainly by modifying their lifestyles;
• Diet
• Behavioural patterns such as adynamia etc)-for instance weight loss has been shown to greatly reduce the risk of progressing to hypertensive heart disease and also associated with an increased life expectancy.
• Secondary prophylaxis which includes frequent screening with special attention on those with risk factors helps to detect and treat hypertension at a much early stage and hence preventing its progression to hypertensive heart disease.

Involving patients in the management of hypertension and hypertensive heart disease is a cornerstone of success; when patients are advised on the type of diet they need to take, what to avoid and how to live their lives, it reduces the need for pharmacological treatment in most cases. However, owing to the fact that patient education is being overlooked most often in hypertensive heart disease and an autonomous decision being made by clinicians on the mode of treatment of the patient, due to issues such as;

• Non compliance and hence failed treatment are now on the rise.
Aside lifestyle modifications which have been shown to greatly slow down the progress of hypertensive heart disease, there are a vast majority of medications that help to control the progress of the disease depending on the variant of hypertensive heart disease of a person.

These medications may include;
• beta blockers
• ACE – inhibitors
• diuretics
• antiplatelets
• antiarrythmic drugs etc.

In conclusion:

Hypertensive heart disease refers to a myriad of complications arising from hypertension. Their onset can be avoided if hypertension is detected early and appropriately treated, and their incidence will drop massively if the general population is well educated on the condition.

Hypertensive heart disease is a life-threatening one, with negative effects on quality of life and life expectancy, however, there are improved ways of ensuring a slower progression of the condition once acquired.

Dr. Bertrand Seidu