Contemporary Diagnosis and Management of Hypertensive Heart Disease

Dear Colleagues,

Hypertensive heart disease refers to a cluster of structural and functional changes in the left ventricle, left atrium, and coronary arteries as a result of chronic hypertension. Chronic elevated blood pressure increases the cardiac workload, resulting in left ventricular hypertrophy and/or fibrosis. It has been well established that left ventricular hypertrophy in patients with hypertension is associated with increased cardiovascular morbidity and mortality. Current treatment follows standard hypertension guidelines for blood pressure control as even the effects of pharmacotherapy on regression of left ventricular hypertrophy are beneficial. While elevated blood pressure is a risk factor for hypertensive heart disease, only a small proportion of the variability in hypertensive heart disease can be explained by blood pressure alone. Other risk factors include older age, ethnicity, overweight status, physical inactivity, excess salt intake, smoking, alcohol, diabetes mellitus, and genetic predisposition. Clinical and hemodynamic stimuli to hypertensive heart disease induce fundamental reconfigurations of the molecular, cellular, and protein components of the endothelium and myocardium. A diagnosis of hypertensive heart disease is established using noninvasive cardiac imaging. Managing hypertensive heart disease is a multi-disciplinary approach that includes lifestyle modification, pharmacotherapy, and management of its complications including heart failure, atrial fibrillation, and coronary artery disease.

Dr. Jonathan Bella
Guest Editor

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