Hypertensive Heart Disease in Older People - Types, Causes, Symptoms, and Management

Introduction:

When a person suffers from unmanaged hypertension for a long time, it can lead to hypertensive heart disease. When the blood pressure is high for a prolonged time, changes occur in the left ventricle, left atrium, and coronary arteries, leading to heart disease. This can lead to diastolic failure or systolic failure, or both over time. The workload of the heart gets increased due to elevated blood pressure. Hypertensive heart disease is considered the most common cause of death due to hypertension. One-fourth of heart failure is caused by hypertension.

What Are the Types of Hypertensive Heart Disease?

• Narrowing of the Arteries: Elevated blood pressure can cause the narrowing of blood vessels. Following this, blood flow to the heart may slow down or even stop. This ends up in coronary artery disease.

• Thickening and Enlargement of the Heart: Increased blood pressure makes the pumping of the heart difficult. This difficulty causes the thickening and growth of heart muscles, which affects the left ventricle, the main pumping chamber of the heart.

What Are Cardiovascular Complications Associated With Hypertension?

Prolonged unmanaged hypertension can lead to the following heart complications:

1. Heart Failure: Heart failure results when the heart does not pump adequate blood.

2. Coronary Heart Disease: It occurs when the blood flow to the heat’s muscles gets reduced due to the deposition of plaques in the arteries of heart.

3. Peripheral Artery Disease: A type of atherosclerosis that develops due to the deposition of fatty plaque in the arteries of legs or arms.

4. Left Ventricular Hypertrophy: It is the thickening of muscles in the left ventricle or lower left chamber of heart.

5. Cardiomegaly: Cardiomegaly is a condition which causes the increase in the size of the heart.

6. Myocardial Ischemia: When the flow of blood to the heart gets reduced, heart muscles won’t receive enough oxygen, which leads to myocardial ischemia.

7. Atherosclerosis: Atherosclerosis occurs when fats, cholesterol, and other substances gets accumulated in the walls of the arteries.

8. Sudden Cardiac Arrest: It refers to sudden loss of entire heart activities.

9. Stroke and Sudden Death: It results from the blockage of blood supply to the brain.

What Are the Risk Factors for Hypertensive Heart Disease?

People with high blood pressure are at the highest risk for hypertensive heart disease. However, other factors that can increase the chance of developing hypertensive heart disease are:

• Being overweight.

• Low or no physical activity.

• Smoking.

• Family history of hypertensive heart disease.

• Men and postmenopausal women.

• Consuming food rich in fat and cholesterol.

• Older age.

What Are the Clinical Manifestations of Hypertensive Heart Disease?

The clinical manifestations of hypertensive heart disease can differ according to the person’s condition and the severity of the disease:

• Chest pain.

• A feeling of pressure or tightness in the chest.

• Extreme tiredness.

• Pain in the shoulder, neck, and arms.

• Persistent cough.

• Loss of appetite.

• Swelling in the ankles or legs.

How Is Hypertensive Heart Disease Diagnosed?

The doctor will inquire about signs and symptoms after taking a medical history. The blood pressure of the patient will be checked and the history of hypertension will be evaluated. Physical examination and lab tests will be conducted to check blood and kidney function.

The following tests are used for diagnosing hypertensive heart disease:

1. Lipid Profile: It is a test that measures the triglycerides and cholesterol levels in the blood. Lipid profile tests will help doctors to know the risk of heart disease and other medical conditions.

2. Basic Metabolic Panel: This test measures the level of different substances in the blood, which include glucose, calcium, sodium, potassium, carbon dioxide, chloride, blood urea nitrogen, and creatinine. Any abnormality in the level of these substances may indicate a serious medical condition.

3. Complete Blood Count: Biomarkers in the blood, such as C-reactive protein, can predict the risk of coronary artery disease. Other components like erythrocyte sedimentation rate, hematocrit, and white blood cell count can also predict the risk of the development of heart conditions.

4. Urine Test: Urine test checks for biomarkers or protein expressions that can predict heart diseases or other chronic medical conditions.

5. Electrocardiogram (ECG): The electrical signals of the heart can be monitored with the help of an ECG. It can detect arrhythmias, coronary artery disease, and other heart conditions. It is an important diagnostic tool for hypertensive heart disease.

6. Echocardiogram: In an echocardiogram, sound waves are used to develop pictures of the heart. It is also known as a heart ultrasound or heart sonogram. It can depict the flow of blood through the heart and heart valves.

7. Coronary Angiography: It is a test to check for any blockage in the coronary arteries. In this test, a contrast dye is administered into the arteries through a catheter, and the blood flow through the heart is analyzed by a doctor by looking at an X-ray screen.

8. Exercise Stress Test: It is advised for people with symptoms such as chest pain. In this test, patients are hooked up to ECG and are asked to exercise on a treadmill. It determines the efficiency of the heart when the body works hard.

9. Nuclear Stress Test: It is also called the thallium stress test and is similar to the exercise stress test. In a nuclear stress test, a dye is inserted into the arm through an intravenous line, and the image of the heart is viewed using a special camera.

What Is the Treatment for Hypertensive Heart Disease in Older People?

The treatment of hypertensive heart disease depends on the age and severity of the disease.

Medications: A combination of the following medications is used for the treatment of hypertensive heart disease.

• Water pills to reduce blood pressure.

• Diuretics remove excess body fluids.

• Vasodilators relax smooth muscles in the arteries.

• Calcium channel blockers improve the flow of oxygen and blood to the heart.

• Beta-blockers decrease the pressure on blood vessels and the heart.

• Thiazide diuretics remove excess salt and water from the body.

• Nitrates to relieve chest pain.

Surgery: In severe cases, doctors advise surgery or implantation of certain devices to increase the blood flow to the heart.

• Pacemaker: It is a device that can produce electrical stimulation to contract the muscles of the heart, which helps in maintaining normal heart rhythm.

• Cardioverter Defibrillators: These are implantable devices that can assess and provide electrical shock whenever required to correct the heart's rhythm.

• Coronary Artery Bypass Graft Surgery: It is a surgical method to treat blockages in coronary arteries and is advised only in cases of severe coronary heart disease.

How Can Older People Prevent Hypertensive Heart Disease?

The most important method to prevent hypertensive heart disease is to maintain normal blood pressure. Making certain lifestyle adjustments can prevent hypertensive heart disease during old age:

• Overweight or obesity are the factors that can increase the risk of both heart disease and hypertension. So it is important to maintain a healthy body weight.

• Give preference to a healthy diet that includes fruits, vegetables, fibers, proteins, etc., and try to avoid foods rich in salt, sugar, and fat.

• Stop smoking and reduce the intake of alcohol.

• Workout regularly for at least 20 to 30 minutes a day.

• Manage stress by practicing stress management techniques like meditation, mindfulness, yoga, breathing exercises, etc.

Conclusion:

Hypertensive heart disease is a chronic condition that affects older people more as age is a risk factor. Unmanaged hypertension for a long time is the cause of this condition. Coronary artery disease, arrhythmia, stroke, atherosclerosis, etc. can occur as a result of hypertensive heart disease. Early diagnosis and proper treatment can help the patient recover from this condition.