High blood pressure increases the heart's workload. 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. This, in turn, may worsen 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 high blood pressure.

Congestive heart failure is one possible result of hypertensive heart disease. Symptoms of congestive heart failure include:

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

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

• Chest pain associated with:
  • Dizziness
  • Nausea
  • Shortness of breath
  • Sweating
• Pressure-type chest pain, particularly with activity

A third possible result is hypertrophic cardiomyopathy .

During a physical examination, the doctor may find the following signs of heart disease:

• Elevated blood pressure
• Enlargement of the heart
• Fluid in the lungs or abnormal heart sounds (heard by listening to the chest with a stethoscope)

Late in the history of the condition, there may be signs of heart failure, including lung (pulmonary) congestion.

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

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

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

The goals of treatment are to reduce blood pressure and control the heart disease. Treatment of heart disease depends on the conditions that are present (acute myocardial infarction, angina , heart failure, and so on).

Common medications include:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor antagonists
• Beta blockers
• Calcium channel blockers
• Direct vasodilators
• Diuretics

Intravenous (given directly into the vein) medications may be prescribed if hypertension is extremely severe and intensive care is necessary.

Blood pressure should be checked at regular intervals (as recommended by your health care provider) to monitor the condition. Frequent blood pressure measurements taken at home are often recommended for people with difficult-to-control high blood pressure.

Diabetes, hyperlipidemia, and other conditions that increase the risk of heart disease should be carefully controlled.

In addition to medications, recommended lifestyle changes include:

• Dietary adjustments -
  • Avoiding trans fats and saturated fats
  • Increasing fruits, vegetables, and low-fat dairy products
  • Reducing sale intake may be beneficial
  • Whole grains, poultry, and fish are also generally recommended
• Exercise
• Reducing excessive alcohol consumption may also help
• Stopping smoking -- cigarettes are a major cause of hypertension-related heart disease
• Weight loss

The risk for complications depends on the how enlarged the left ventricle has become. The larger this section of the heart becomes, the greater the chance of complications. Treating high blood pressure may reduce the amount of left ventricle damage.

Several studies have shown that most blood pressure medications (anti-hypertensives), and particularly drugs that affect angiotensin, can reverse left ventricular hypertrophy and prolong survival in people with heart failure from hypertensive heart disease.

Nonetheless, this is a serious disease that carries the risk of sudden death.

• Angina
• Arrhythmias
• Heart attack
• Heart failure
• Sudden death

Call your health care provider if you have high blood pressure and develop any symptoms.

Treat your high blood pressure. Do not stop or change treatment, except on the advice of your health care provider. Monitor your blood pressure as advised.

Eat a diet low in fat and rich in fruits and vegetables, exercise regularly, and avoid smoking.

Hare JM. The dilated, restrictive, and infiltrative cardiomyopathies. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa; Saunders Elsevier; 2007: chap 64.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa; Saunders Elsevier; 2007: chap 25.