Hypertensive cardiomyopathy: A clinical approach and literature review

Abstract

Hypertensive cardiomyopathy (HTN-CM) is a structural cardiac disorder generally accompanied by concentric left ventricular hypertrophy (LVH) associated with diastolic or systolic dysfunction in patients with persistent systemic hypertension. It occurs in the absence of other cardiac diseases capable of causing myocardial hypertrophy or cardiac dysfunction. Persistent systemic hypertension leads to structural and functional myocardial abnormalities resulting in myocardial ischemia, fibrosis, and hypertrophy. HTN-CM is predominantly a disease of impaired relaxation rather than impaired contractility, so patients are usually asymptomatic during resting conditions. However, their stiff left ventricles become incapable of handling increased blood volume and cannot produce appropriate cardiac output with the slight change of circulating volume that may occur during exercise. Importantly, the accompanying LVH is itself a risk factor for mortality and morbidity. Therefore, early detection of LVH development in patients with hypertension (referred to as HTN-CM) is critical for optimal treatment. In addition to pathological findings, echocardiography and cardiac magnetic resonance imaging are ideal tools for the diagnosis of HTN-CM. Timely diagnosis of this condition and utilization of appropriate treatment are required to improve morbidity and mortality in hypertensive patients. This review article presents an overview of the multidimensional impact of myocardial disorder in patients with hypertension. Relevant literature is highlighted and the effects of hypertension on cardiac hypertrophy and heart failure development are discussed, including possible therapeutic options.

Keywords: Hypertension, Diagnosis, Cardiomyopathy, Hypertrophy, Risk assessment

Core tip: Hypertensive cardiomyopathy is a structural cardiac disorder generally accompanied by left ventricular hypertrophy associated with diastolic and/or systolic dysfunction in patients with persistent systemic hypertension, in the absence of other cardiac diseases. Because regression of myocardial hypertrophy is associated with a reduction in cardiovascular risk along with the improvement of cardiac function, timely diagnosis of the disease-specific pathophysiology and appropriate treatment strategy including maintaining optimal blood pressure control is very important in the care of patients with hypertension. In the present review manuscript, we have described the outline of hypertensive cardiomyopathy, pathophysiological feature of the disease, diagnosis and the treatment.