3/7/2014 Hypertensive Heart Disease

http://emedicine.medscape.com/article/162449-overview#a30 1/5
Hypertensive Heart Disease
Author: Kamran Riaz, MD; Chief Editor: Yasmine Subhi Ali, MD, MSCI, FACC, FACP more...

Updated: Dec 5, 2013
Other Studies
Histology
Gross findings
LVH (concentric) occurs without dilatation of the LV (see the image below). The ratio of wall thickness to the
radius of the ventricular chamber increases. LV wall thickness may exceed 2cm, and the heart weight exceeds
500g. Dilatation of the ventricular chamber, thinning of the walls, and enlargement of the external dimensions of the
heart occur with the onset of decompensation.
Gross specimen of the heart with concentric lef t ventricular hypertrophy.
Microscopic findings
The earliest changes in hypertensive heart disease include myocyte enlargement, with an increase in the
myocytes' transverse diameters. At a more advanced stage, cellular and nuclear enlargement (with variation in cell
size), loss of myofibrils, and interstitial fibrosis occur. (See the images below.)
Histologic section of the myocardium showing a cross-section of coronary artery af f ected by atherosclerosis and myocyte hypertrophy.
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Histologic section of the heart showing the hypertrophied myocytes and f ibrosis accompanying lef t ventricular hypertrophy.
Histologic section of an autopsy myocardial specimen f rom a patient with long-standing hypertension and associated coronary artery
disease. The slide shows myocardial hypertrophy, contraction bands (typical of lef t ventricular hypertrophy), and "car box" nuclei.
Cardiac catheterization
Cardiac catheterization is used for the diagnosis of coronary artery disease and helps to assess the severity of
elevated pulmonary artery pressure in patients with heart failure.
Sleep evaluation
Sleep evaluation and additional tests for excluding other secondary causes of hypertension may be indicated.

Contributor Information and Disclosures
Author
Kamran Riaz, MD Clinical Assistant Professor, Department of Internal Medicine, Section of Cardiology,
Wright State University, Boonshoft School of Medicine
Kamran Riaz, MD is a member of the following medical societies: American College of Cardiology, American
College of Physicians, American Society of Echocardiography, Ohio State Medical Association, and Royal
College of Physicians
Disclosure: Nothing to disclose.
Coauthor(s)
Aqeel Ahmed, MD Resident Physician, Department of Pathology, University of Missouri-Kansas City School
of Medicine
Aqeel Ahmed, MD is a member of the following medical societies: American Society for Clinical Pathology
Disclosure: Nothing to disclose.
Chief Editor
Yasmine Subhi Ali, MD, MSCI, FACC, FACP President, Nashville Preventive Cardiology, PLLC; Assistant
Clinical Professor of Medicine, Vanderbilt University School of Medicine
Yasmine Subhi Ali, MD, MSCI, FACC, FACP is a member of the following medical societies: American College
of Cardiology, American College of Physicians, American Heart Association, American Medical Association,
3/7/2014 Hypertensive Heart Disease
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National Lipid Association, and Tennessee Medical Association
Disclosure: Nothing to disclose.
Additional Contributors
Alan D Forker, MD Professor of Medicine, University of Missouri at Kansas City School of Medicine; Director,
Outpatient Lipid Diabetes Research, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of
Cardiology, American College of Physicians, American Heart Association, American Medical Association,
American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee
with no personal profit; Speakers Bureau Honoraria Speaking and teaching
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center
College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
References
1. Kannel WB, Cobb J. Left ventricular hypertrophy and mortality--results from the Framingham Study.
Cardiology. 1992;81(4-5):291-8. [Medline].
2. Yamasaki N, Kitaoka H, Matsumura Y, et al. Heart failure in the elderly. Intern Med. May 2003;42(5):383-
8. [Medline].
3. Cabezas M, Comellas A, Ramon Gomez J, et al. [Comparison of the sensitivity and specificity of the
electrocardiography criteria for left ventricular hypertrophy according to the methods of Romhilt-Estes,
Sokolow-Lyon, Cornell and Rodriguez Padial]. Rev Esp Cardiol. Jan 1997;50(1):31-5. [Medline].
4. Kahn S, Frishman WH, Weissman S, et al. Left ventricular hypertrophy on electrocardiogram: prognostic
implications from a 10-year cohort study of older subjects: a report from the Bronx Longitudinal Aging
Study. J Am Geriatr Soc. May 1996;44(5):524-9. [Medline].
5. Shimbo D, Muntner P, Mann D, Barr RG, Tang W, Post W, et al. Association of left ventricular
hypertrophy with incident hypertension: the multi-ethnic study of atherosclerosis. Am J Epidemiol. Apr 15
2011;173(8):898-905. [Medline].
6. Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with
hypertension. N Engl J Med. Jan 4 2001;344(1):17-22. [Medline].
7. Ghali JK, Kadakia S, Cooper RS, Liao YL. Impact of left ventricular hypertrophy on ventricular arrhythmias
in the absence of coronary artery disease. J Am Coll Cardiol. May 1991;17(6):1277-82. [Medline].
8. Jouven X, Desnos M, Guerot C, Ducimetiere P. Predicting sudden death in the population: the Paris
Prospective Study I. Circulation. Apr 20 1999;99(15):1978-83. [Medline].
9. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national
implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial
Fibrillation (ATRIA) Study. JAMA. May 9 2001;285(18):2370-5. [Medline].
10. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart disease and
stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and
Stroke Statistics Subcommittee. Circulation. Jan 27 2009;119(3):e21-181. [Medline].
11. Peacock F, Amin A, Granger CB, et al. Hypertensive heart failure: patient characteristics, treatment, and
outcomes. Am J Emerg Med. Oct 2011;29(8):855-862. [Medline].
3/7/2014 Hypertensive Heart Disease
http://emedicine.medscape.com/article/162449-overview#a30 4/5
12. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. May
21 2003;289(19):2560-72. [Medline].
13. [Guideline] Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, et al. 2013
ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. Nov 12 2013;
[Medline]. [Full Text].
14. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic
assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. Feb 15
1986;57(6):450-8. [Medline].
15. [Best Evidence] Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment
of hypertension in patients 80 years of age or older. N Engl J Med. May 1 2008;358(18):1887-98.
[Medline].
16. Elmer PJ, Grimm R Jr, Laing B, et al. Lifestyle intervention: results of the Treatment of Mild Hypertension
Study (TOMHS). Prev Med. Jul 1995;24(4):378-88. [Medline].
17. Hajjar IM, Grim CE, George V, Kotchen TA. Impact of diet on blood pressure and age-related changes in
blood pressure in the US population: analysis of NHANES III. Arch Intern Med. Feb 26 2001;161(4):589-
93. [Medline].
18. Hypertension Prevention Trial Research Group. The Hypertension Prevention Trial: three-year effects of
dietary changes on blood pressure. Arch Intern Med. Jan 1990;150(1):153-62. [Medline].
19. Aguilera MT, de la Sierra A, Coca A, et al. Effect of alcohol abstinence on blood pressure: assessment
by 24-hour ambulatory blood pressure monitoring. Hypertension. Feb 1999;33(2):653-7. [Medline].
20. Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension
in women. JAMA. Jul 22 2009;302(4):401-11. [Medline]. [Full Text].
21. Cook NR, Cutler JA, Obarzanek E, Buring JE, Rexrode KM, Kumanyika SK. Long term effects of dietary
sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension
prevention (TOHP). BMJ. Apr 28 2007;334(7599):885. [Medline].
22. Conlin PR, Chow D, Miller ER 3rd, et al. The effect of dietary patterns on blood pressure control in
hypertensive patients: results from the Dietary Approaches to Stop Hypertension (DASH) trial. Am J
Hypertens. Sep 2000;13(9):949-55. [Medline].
23. Conlin PR. The dietary approaches to stop hypertension (DASH) clinical trial: implications for lifestyle
modifications in the treatment of hypertensive patients. Cardiol Rev. Sep-Oct 1999;7(5):284-8. [Medline].
24. Moore TJ, Vollmer WM, Appel LJ, et al. Effect of dietary patterns on ambulatory blood pressure : results
from the Dietary Approaches to Stop Hypertension (DASH) Trial. DASH Collaborative Research Group.
Hypertension. Sep 1999;34(3):472-7. [Medline].
25. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the
Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N
Engl J Med. Jan 4 2001;344(1):3-10. [Medline].
26. Svetkey LP, Sacks FM, Obarzanek E. The DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-
sodium): rationale and design. DASH-Sodium Collaborative Research Group. J Am Diet Assoc. Aug
1999;99(8 Suppl):S96-104. [Medline].
27. Manolio TA, Levy D, Garrison RJ, et al. Relation of alcohol intake to left ventricular mass: The
Framingham Study. J Am Coll Cardiol. Mar 1 1991;17(3):717-21. [Medline].
28. Klatsky AL, Friedman GD, Armstrong MA. The relationships between alcoholic beverage use and other
traits to blood pressure: a new Kaiser Permanente study. Circulation. Apr 1986;73(4):628-36. [Medline].
3/7/2014 Hypertensive Heart Disease
http://emedicine.medscape.com/article/162449-overview#a30 5/5

Medscape Reference 2011 WebMD, LLC
29. [Best Evidence] Sinha R, Cross AJ, Graubard BI, Leitzmann MF, Schatzkin A. Meat intake and mortality:
a prospective study of over half a million people. Arch Intern Med. Mar 23 2009;169(6):562-71. [Medline].
30. Kokkinos PF, Papademetriou V. Exercise and hypertension. Coron Artery Dis. Mar 2000;11(2):99-102.
[Medline].
31. Mahamat A, Richard F, Arveiler D, et al. Body mass index, hypertension and 5-year coronary heart
disease incidence in middle aged men: the PRIME study. J Hypertens. Mar 2003;21(3):519-24. [Medline].
32. [Best Evidence] Jamerson K, Weber MA, Bakris GL, Dahlf B, Pitt B, Shi V, et al. Benazepril plus
amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. Dec 4
2008;359(23):2417-28. [Medline].
33. Henderson BC, Sen U, Reynolds C, Moshal KS, Ovechkin A, Tyagi N. Reversal of systemic
hypertension-associated cardiac remodeling in chronic pressure overload myocardium by ciglitazone. Int
J Biol Sci. 2007;3(6):385-92. [Medline].
34. Sudano I, Flammer AJ, Priat D, Enseleit F, Hermann M, Wolfrum M, et al. Acetaminophen increases
blood pressure in patients with coronary artery disease. Circulation. Nov 2 2010;122(18):1789-96.
[Medline].
35. Weir RA, McMurray JJ, Puu M, Solomon SD, Olofsson B, Granger CB, et al. Efficacy and tolerability of
adding an angiotensin receptor blocker in patients with heart failure already receiving an angiotensin-
converting inhibitor plus aldosterone antagonist, with or without a beta blocker. Findings from the
Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Added trial.
Eur J Heart Fail. Feb 2008;10(2):157-63. [Medline].
36. Okin PM, Devereux RB, Harris KE, Jern S, Kjeldsen SE, Julius S. Regression of electrocardiographic left
ventricular hypertrophy is associated with less hospitalization for heart failure in hypertensive patients.
Ann Intern Med. Sep 4 2007;147(5):311-9. [Medline].
37. Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bhm M. Renal sympathetic denervation
in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled
trial. Lancet. Dec 4 2010;376(9756):1903-9. [Medline].
38. Bisognano JD, Bakris G, Nadim MK, et al. Baroreflex activation therapy lowers blood pressure in patients
with resistant hypertension results from the double-blind, randomized, placebo-controlled rheos pivotal
trial. J Am Coll Cardiol. Aug 9 2011;58(7):765-73. [Medline].
39. Burke AP, Farb A, Liang YH, et al. Effect of hypertension and cardiac hypertrophy on coronary artery
morphology in sudden cardiac death. Circulation. Dec 15 1996;94(12):3138-45. [Medline].
40. Liao Y, Cooper RS, Mensah GA, McGee DL. Left ventricular hypertrophy has a greater impact on survival
in women than in men. Circulation. Aug 15 1995;92(4):805-10. [Medline].
41. Leung AA, Wright A, Pazo V, Karson A, Bates DW. Risk of Thiazide-induced Hyponatremia in Patients
with Hypertension. Am J Med. Nov 2011;124(11):1064-72. [Medline].