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An update on hypertensive heart disease
Longstanding and uncontrolled arterial hypertension is frequently associated
with a hypertensive heart disease with / without heart failure.
Hypertensive heart disease in its full expression is characterised by left
ventricular hypertrophy, diastolic dysfunction and a mostly preserved
ejection fraction. Several ECG criteria have been suggested for the detection
of left ventricular hypertrophy. All these criteria have in common poor
sensitivity, while the specificity is relatively high. The search for atrial
fibrillation, which is frequently asymptomatic, is a key indication for an
ECG in patients with arterial hypertension. This arrhythmia is a major consequence
of hypertensive heart disease, and its detection has important
clinical consequences, in particular prophylaxis of thromboembolic
events. Transthoracic echocardiography is much more sensitive than the
ECG for the detection of left ventricular hypertrophy and also allows determination
of diastolic and systolic left ventricular function and exclusion of
important differential diagnoses of left ventricular hypertrophy. As a consequence
of the impaired ventricular filling (diastolic dysfunction), heart
failure may evolve which, in the case of preserved ejection fraction, is referred
to as heart failure with preserved ejection fraction (HFpEF). In this
situation, consequent control of blood pressure (and rate control in the
case of rapidly conducted atrial fibrillation) play a pivotal role. No largescale,
randomised study with a specific drug has shown a relevant reduction
of hard clinical endpoints in HFpEF patients up to the present day.