| Hypertensive heart disease refers to heart conditions that develop as a result of uncontrolled high blood pressure (hypertension). Ten percent of individuals with chronic hypertension develop enlarged left ventricles (left ventricular hypertrophy, or LVH). Enlargement of the left ventricle puts the individual at greater risk of illness and death (morbidity and mortality) due to congestive heart failure, heart rhythm irregularities (ventricular arrhythmias, atrial fibrillation), and heart attack (myocardial infarction). For these reasons, an enlarged left ventricle in association with hypertension is considered the definitive sign of hypertensive heart disease.
Essential or chronic hypertension develops as a result of complex interactions between genetic influences and dietary and lifestyle factors; it has no definitive cause and no cure, although blood pressure can usually be controlled with combinations of drug therapy and diet and lifestyle modifications. Blood pressure is dependent on the output of the heart (cardiac output), the condition of the blood vessels (vasculature), and the kidneys’ ability to regulate fluid balance in the body. Part of normal kidney function is to remove dietary sodium (renal sodium excretion), which becomes harder to do when excess sodium is ingested. High sodium intake, in turn, can lead to water retention, resulting in high blood pressure. The narrowing of blood vessels contributes to high blood pressure by constricting the flow of blood (increased vascular resistance), which requires greater pressure to move the blood through the system. If blood pressure remains uncontrolled because the individual is not aware of the condition or has not been in compliance with prescribed drug therapies and dietary or lifestyle changes, the high blood pressure levels will affect the performance of the left side of the heart, and the left ventricle will become enlarged.
Although an enlarged ventricle indicates that hypertensive heart disease is present, early treatment, especially regulation of blood pressure, can prevent future serious heart complications. Most individuals respond well to drug therapy for hypertension and associated cardiac problems, which usually results in a reduction of the size of the left ventricle.
The risk for hypertensive heart disease increases as blood pressure values increase. Two- to threefold increases in risk for congestive heart failure occurred among hypertensive adults in the well-known Framingham Heart Study (Oparil).Risk: The occurrence of hypertensive heart disease, unlike hypertension itself, is more prevalent among men in any age group. Hypertensive heart disease affects blacks more than whites and the elderly more than young people. Incidence and Prevalence: In the U.S, approximately 58 million people have hypertension. Of the 58% who receive treatment for the condition, only 31% are controlled. In individuals with hypertension, 27% will fall victim to the disease consequences from prolonged periods of elevated blood pressure (Schwartz). |
Source: Medical Disability Advisor
| History: Individuals with hypertensive heart disease may report headaches, chest pain, swollen feet, fatigue, and shortness of breath on exertion and/or at rest. The individual may report episodes of interrupted sleep due to breathing problems (paroxysmal nocturnal dyspnea), a symptom characteristic of congestive heart failure, or may have noticed an irregular heartbeat or rapid pulse. They may have no knowledge of having high blood pressure or may report being diagnosed with hypertension and may have had drug therapy prescribed or dietary and lifestyle changes recommended. A family history of high blood pressure may be reported. Physical exam: High blood pressure (hypertension) is present, although the values and level of severity vary considerably among individuals. Changes in the small blood vessels (arterioles) of the eyes may be noted during examination. The pulse may be irregular or rapid. Listening to the heart through a stethoscope (auscultation) may reveal an irregular heart rhythm, heart murmurs, or extra heart sounds (gallops). In advanced cases of hypertensive heart disease, the individual may have an enlarged liver, swelling of the feet and ankles, and other signs of congestive heart failure. Tests: An electrocardiogram, echocardiogram, and chest x-ray are typically performed to confirm an enlarged left ventricle and related cardiac abnormalities. Blood tests may include cardiac enzymes and electrolytes. Renal function may be evaluated by collecting a 24-hour urine specimen and measuring the filtration rate of the kidneys (glomerular filtration rate). Blood serum levels of protein (albumin) and blood urea nitrogen (BUN) may also be measured. |
Source: Medical Disability Advisor
| Intervention for hypertensive heart disease includes drug therapy to control blood pressure and modifications of diet and lifestyle. Several classes of drugs may be prescribed in the treatment of hypertension, including diuretics, beta-blockers, ACE inhibitors, calcium channel blockers, angiotensin II receptor antagonists, and alpha-blockers. The type of drug therapy selected is based on coexisting medical conditions, lifestyle issues, safety, and tolerance of the drug.
A combination of drugs may be more effective when controlling blood pressure and symptoms in individuals whose hypertension is resistant to ordinary treatment (refractory) or whose hypertension is complicated by other underlying medical conditions. For example, if a beta-blocker, ACE inhibitor, or angiotensin II blocker is used as the primary drug, a diuretic may be added as a secondary drug. Another approach may be to use low-dose combinations of anti-hypertensive drugs, such as a beta-blocker with a calcium channel blocker.
Dietary and lifestyle modifications are a cornerstone of therapy and can substantially reduce illness and death (morbidity and mortality). In general, individuals are advised to reduce salt and high-sodium foods in the diet as well as to discontinue alcohol consumption and smoking. The individual may be advised to lose weight and to exercise regularly. |
Source: Medical Disability Advisor
| Drug therapy and lifestyle modifications can control blood pressure and lessen the risk of congestive heart failure or other cardiomyopathy and will usually reverse left ventricular enlargement. |
Source: Medical Disability Advisor
| Physical therapy benefits individuals with hypertensive heart disease by applying principles of aerobic conditioning. Rehabilitation, usually planned in four phases, takes place in a hospital or cardiac rehab setting.
Phase 1 often begins at low levels of intensity with individuals monitored for heart rate, rhythm, and blood pressure. At this stage, exercise is aimed primarily at preventing the hazards of bed rest, reducing episodes of low blood pressure when changing positions (orthostatic hypotension), and maintaining overall mobility of the body. The intensity of the exercise is gradually increased until discharge from the hospital. It may include stair climbing and riding a stationary bicycle, for example.
Phase 2 usually begins after the individual is discharged from the hospital and will be done in an outpatient setting such as a rehab center. Individuals who have not been hospitalized may also begin at this phase. The individual performs exercises similar to those in phase 1, with progression in duration and intensity as the individual is able. The therapy focuses on improving functional capacity by increasing physical endurance and promoting return to activity. An electrocardiograph is attached to the individual to record the continuous electrical activity of the heart muscle. A physical therapist keeps a daily log of the individual's blood pressure, heart rate, and cardiac rhythm.
Phase 3 continues in an outpatient setting such as a rehab center, anywhere from 3 to 6 months after the start of rehabilitation. A physical therapist experienced in cardiac rehabilitation keeps a daily log of the individual's blood pressure, heart rate, and cardiac rhythm. Individuals may continue to be monitored with an electrocardiograph to observe activity of the heart muscle. Depending on the individual's condition, this phase may last for several months. Individuals may stay involved with an outpatient program for up to a year to accomplish all of their goals while still not resuming a full work schedule. Higher levels of exercise may begin during this phase, with the addition of recreational activities such as swimming and hiking. Light jogging and cycling is appropriate as long as the individual can tolerate the activity.
Phase 4 of cardiac rehabilitation for hypertensive heart disease occurs about 12 months after discharge from the hospital. Long-term maintenance of performance levels reached during phases 2 and 3 becomes a concern at this time. Aerobic exercises that increase cardiovascular fitness are emphasized and include exercises such as walking briskly, running, jogging, swimming, climbing stairs, or bicycling. Throughout all phases, it is important to allow the heart rate to gradually return to normal by cooling down slowly after exercise. |
Source: Medical Disability Advisor
| Cardiac complications of hypertension include left ventricle hypertrophy, left ventricular diastolic dysfunction, asymptomatic coronary artery disease, congestive heart failure, ventricular arrhythmias, myocardial ischemia, stroke, heart attack, cognitive dysfunction, kidney disease, and sudden death. |
Source: Medical Disability Advisor
| The individual may require less stressful or physically demanding duties. For instance, individuals with jobs that require exertion, operation of commercial vehicles, or operation of heavy equipment may need to be reassigned to less strenuous responsibilities. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has diagnosis of hypertensive heart disease been confirmed?
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Does individual have an enlarged left ventricle (left ventricular hypertrophy)?
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Does individual continue to complain of symptoms associated with congestive heart failure, such as shortness of breath, weight gain, swollen ankles, cough, and nocturnal dyspnea?
Regarding treatment:
- Has drug therapy been effective?
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Is individual's current drug therapy based on coexisting medical conditions, lifestyle issues, safety, and tolerance of the drug?
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Would a combination of drugs be more effective?
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Has individual complied with lifestyle modifications such as reducing salt in the diet, limiting alcohol consumption, and losing weight?
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Has individual been able to stop smoking?
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Has individual replaced a sedentary lifestyle with regular exercise?
Regarding prognosis:
- Do symptoms persist despite treatment?
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What alterations in drug therapy can now be made that might better accomplish treatment goals?
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Has individual been able to accomplish lifestyle modifications?
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Would individual benefit from enrollment in community support programs such as an alcohol treatment program (AA), smoking cessation program, exercise program (through local gym or recreation service), or weight loss program (such as Weight Watchers)?
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Would individual benefit from nutrition counseling?
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Does individual have a coexisting condition (such as coronary artery disease, renal disease, liver disease, diabetes mellitus) that may complicate treatment or affect recovery?
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Source: Medical Disability Advisor
| Oparil, S. "Arterial Hypertension." Cecil Textbook of Medicine. Eds. Lee Goldman and J. Claude Bennett. 21st ed. Philadelphia: W.B. Saunders, 2000. 259-264.Schwartz, Gary L., and Sheldon G. Sheps. "Hypertension." Medscape. 6 May. 2004. WebMD Inc. 17 Dec. 2004 <http://www.medscape.com/viewarticle/474790>. |
Source: Medical Disability Advisor
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