Hypertensive heart disease is a late complication of hypertension (high blood pressure) in which the heart is affected.

High blood pressure increases the heart's workload, and over time, this can cause the heart muscle to thicken. As the heart pumps against elevated pressure in the blood vessels, the left ventricle becomes enlarged and the amount of blood pumped by the heart each minute (cardiac output) goes down. Without treatment, symptoms of congestive heart failure may develop.

High blood pressure is the most common risk factor for heart disease and stroke. It can cause ischemic heart disease (decreased blood to the heart muscle that results in anginal chest pain and heart attacks) from the increased supply of oxygen needed by the thicker heart muscle.

High blood pressure also contributes to thickening of the blood vessel walls, which in turn may aggravate atherosclerosis (increased cholesterol deposits in the blood vessels). This also increases the risk of heart attacks and stroke.

Hypertensive heart disease is the leading cause of illness and death from hypertension. It affects approximately 7 out of 1,000 people.

High blood pressure is known as a silent killer, because by the time symptoms of hypertensive heart disease appear, the condition can be life-threatening. Congestive heart failure is one possible result of hypertensive heart disease. Symptoms of congestive heart failure include:

• Shortness of breath, especially with activity
• Waking at night with shortness of breath
• Need to sleep with the head elevated to avoid shortness of breath
• Rapid or irregular pulse
• Sensation of feeling the heart beating (palpitations)
• Cough, which may produce frothy or bloody mucus
• Fatigue, weakness, faintness
• Swelling of the feet and ankles
• Increased frequency of urination at night

Ischemic heart disease is another possible result of hypertensive heart disease. Symptoms include:

• Chest pain, pressure-type, particularly with exertion
• Chest pain associated with:
  • Nausea
  • Sweating
  • Dizziness
  • Shortness of breath

A third possible result is hypertrophic cardiomyopathy.

Signs of heart disease are found during a physical examination. The blood pressure is elevated. Enlargement of the heart may be noted. Listening to the chest with a stethoscope may reveal fluid in the lungs or abnormal heart sounds. Late in the history of the condition, there may be signs of heart failure, including pulmonary (lung) congestion.

An ECG may be abnormal, showing an enlarged heart, an irregular heart beat, or evidence of ischemia (lack of oxygen to the heart muscle).

Enlargement of the heart or decreased heart functioning may be seen on:

• An echocardiogram
• A chest x-ray
• A chest CT scan (rarely performed for this diagnosis)
• A coronary angiogram