Cardiovascular Changes during Chronic Hypertensive States

Title: Cardiovascular Changes during Chronic Hypertensive States

Authors: Swathi.A, T.A.Naufal Rizwan

DOI: http://dx.doi.org/10.18535/jmscr/v4i8.69

Abstract

References

Corresponding Author

Abstract

Hypertension is currently the single most important contributor to death around the world in both developed and developing regions. Elevated blood pressure is a major risk factor for coronary heart disease, atrial fibrillation, heart failure, cerebrovascular disease and peripheral artery disease.

Hypertensive heart disease consists of both vascular and myocardial changes. Various mechanisms are responsible for hypertensive heart disease, including endothelial dysfunction and coronary arteriolar constriction causing ischemia of the myocardium, increased fibrosis, apoptosis and inflammatory changes. Studies also shown that major risk factors such as dyslipidemia and also diabetes stratifies the patient into high risk group. Hypertension induces a compensatory thickening of the ventricular wall in an attempt to normalize wall stress, which results in concentric LVH, which in turn decreases LV compliance and LV diastolic filling, causing heart failure. Enlargement of the left atrium results in stretching of the atrial fibers, causing arrythmias and increased blood flow causes damage and narrowing of arteries resulting in coronary artery disease.

Key Words: Hypertension, heart failure, endothelial dysfunction, left ventricular hypertrophy.

References

1. Frohlich ED, Apstein C, Chobanian AV, Devereux RB, Dustan HP, Dzau V, Fauad-Tarazi F, Horan MJ, Marcus M, Massie B, Pfeffer MA, Re RN, Roccella EJ, Savage D, Shub C. The heart in hypertension. N Engl J Med. 1992;327:998–1008. CrossRef MedlineGoogle Scholar

2. Sun SS, Grave GD, Siervogel RM, Pickoff AA, Arslanian SS, Daniels SR. Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics. 2007;119:237–246. doi: 10.1542/peds.2006-2543. [PubMed] [Cross Ref]

3. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, List of authors Task Force Members 2013 ESH/ESC guidelines for management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertens. 2013;31:12811357doi:10.1097/01.hjh.0000431740.32696.cc. [PubMed] [Cross Ref]

4. The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) Eur Heart J. 2012;33:1635–1701. doi: 10.1093/ eurheartj/ehs092. [PubMed] [Cross Ref]

5. Frohlich ED. An updated concept of left ventricular hypertrophy risk in hypertension. Ochsner J. 2009;9:181–190. [PMC free article] [PubMed]

6. Raman SV. The hypertensive heart. J Am Coll Cardiol. 2010;55:91–96. doi: 10.1016/j.jacc.2009.07.059. [PMC free article] [PubMed] [Cross Ref]

7. Schillaci G, Pasqualini L, Verdecchia P, Vaudo G, Marchesi S, Porcellati C, de Simone G, Mannarino E. Prognostic significance of left ventricular diastolic dysfunction in essential hypertension. J Am Coll Cardiol. 2002;39:2005–2011. doi: 10.1016/S0735-1097(02)01896-X. [PubMed] [Cross Ref]

8. D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561–1566. CrossRefMedlineGoogle Scholar

9. WS, Larson MG, Levy D. Impact of left ventricular structure on the incidence of hypertension: the Framingham Heart Study. Circulation. 1994;90:179–185.

10. Berk BC, Fujiwara K, Lehoux S. ECM remodeling in hypertensive heart disease. J Clin Invest. 2007;117:568–575. CrossRefMedlineGoogle Scholar

11. Spinale FG. Myocardial matrix remodeling and the matrix metalloproteinases: influence on cardiac form and function. Physiol Rev. 2007;87:1285–1342.

12. Verdecchia P, Staessen JA, Angeli F, de Simone G, Achilli A, Ganau A, Mureddu G, Cede S, Maggioni AP, Lucci D, Reboldi G. Usual versus tight control of systolic blood pressure in nondiabetic patients with hypertension (Cardio-Sis): an open-label randomised trial. Lancet. 2009;374:525–533. CrossRefMedlineGoogle Scholar

13. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, Vargiu P, Simongini I, Laragh JH. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19:1550–1558. doi: 10.1016/0735- 1097(92)90617-V. [PubMed] [Cross Ref]

14. Wood P, Piran S, Liu PP. Diastolic heart failure: progress, treatment challenges, and prevention. Can J Cardiol. 2011;27:302–310. doi: 10.1016/j.cjca.2011.02.008. [PubMed] [Cross Ref]

15. Tsze DS, Valente JH (2011) Pediatric stroke: a review. Emerg Med Int 2011: Article ID 734506 [PMC free article] [PubMed]

16. Jordan LC, Hillis AE. Challenges in the diagnosis and treatment of pediatric stroke. Nat Rev Neurol. 2011;7:199–208. doi: 10.1038/nrneurol.2011.23. [PMC free article] [PubMed] [Cross Ref]

17. Chlopicki S, Gryglewski RJ. Angiotensin converting enzyme (ACE) and hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitors in the forefront of pharmacology of endothelium. Pharmacol Rep. 2005;57(Suppl):86–96. [PubMed]

18. Tousoulis D, Antoniades C, Stefanadis C. Evaluating endothelial function in humans: a guide to invasive and non-invasive techniques. Heart. 2005;91:553–558. doi: 10.1136/hrt.2006.032847. [PMC free article] [PubMed] [Cross Ref]

19. Johnstone LM, Jones CL, Grigg LE, Wilkinson JL, Walker RG, Powell HR. Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int. 1996;50:998–1006. doi: 10.1038/ki.1996.401. [PubMed] [Cross Ref]

20. Drozdz D, Kordon Z, Pietrzyk JA, Drozdz M, Rudzinski A, Zachwieja K. The assessment of heart function in children with chronic kidney disease (CKD) Pol Merkur Lekarski. 2008;24(Suppl 4):98–100. [PubMed]

Abstract

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Call For Paper Volume 12 Issue 12 December 2024

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