Mechanisms and management of hypertensive heart disease: from left ventricular hypertrophy to heart failure.
Hypertensive heart disease (HHD) is a spectrum of abnormalities that represents the accumulation of a lifetime of functional and structural adaptations to increased blood pressure load. Left ventricular hypertrophy (LVH), increasing vascular and ventricular stiffness,and diastolic dysfunction are prominent intermediate features of this syndrome that operate in parallel with ischemic heart disease and ultimately cause heart failure (HF) if inadequately treated. Outcomes in HHD and HF are improved by antihypertensive drugs at any stage of the condition. This review describes an integrated model of the natural history, pathogenesis, and drug treatment of hypertensive heart disease that is consistent with the recommendations of the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, including an important modification to the HF guideline published by the American College of Cardiology and the American Heart Association that includes LVH and diastolic dysfunction as treatable conditions within the HHD-HF continuum.
Izzo
Joseph L
JL
State University of New York at Buffalo, Buffalo, NY 14215, USA. jizzo@buffalo.edu
Gradman
Alan H
AH
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002423:Cause of Death; D003971:Diastole; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000517:prevention & control; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000517:prevention & control; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000379:methods* / Q000592:standards; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D013599:Systole; D016896:Treatment Outcome; D020257:Ventricular Remodeling
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists