Hypertension and Heart Disease – what is the connection?

January 14 04:00 2017 Print This Article

Summary: 

Hypertension is one of the leading risk-factors for cardiovascular disease worldwide, and the number one risk-factor in India. Hypertension or high blood-pressure damages the heart and affects blood-flow, in three different ways. All these contribute to escalating health risks in different body-systems. In this article, we will explore the risk to heart disease only. Or why hypertension increases the risk for heart disease.

Introduction

Hypertension or high blood-pressure is on the rise worldwide and in India too. According to the World Health Organization, 1 in 4 adults in India have hypertension. Stress, sedentary lifestyle, unhealthy diet and substance abuse are all contributing factors.

Hypertension affects various parts of the body such as the brain, kidneys, eyes and genitals. Above all these, it affects the heart and is the number one risk-factor for cardiovascular disease (CVD) in India. In fact, as much as 30% of adults in India who have CVD, also have hypertension. The connection between the two results in a unique condition or ailment called Hypertensive Heart Disease or HHD.

Causes for HHD

The heart is made up of various muscles, major blood-vessels that carry pure or impure blood in and out of the heart, valves, and conduction systems that provide electrical signals for its proper functioning. Both – the blood-vessels and heart-muscles are quite sturdy to bear the strain of working all through the person’s lifetime. At the same time, they are quite elastic or flexible to accommodate changing blood-flow patterns that happen all the time, as well as various eventualities that can affect blood-pressure.

The heart pumps blood to various parts of the body, at a nearly constant pressure that is 80×120 mm of Hg. When the ventricles contract, the blood is pushed out of the heart at a pressure called the systolic blood-pressure, which is around 120 mm Hg in healthy conditions. When the ventricles relax, blood fills up in the heart and this relaxed pressure is around 80 mm Hg in healthy conditions, and called diastolic blood-pressure.

The blood-pressure is not always 80×120 and varies constantly, due to various reasons. Systolic pressure can shoot up to 150- or 160-mm Hg while diastolic pressure can drop to 70- or 60-mm Hg. Chronic hypertension is a condition in which, the person’s BP hovers around 130×90 or more (140×100 or 150×110) for a fairly long duration. It causes the following eventualities in the heart:

• Coronary Artery Disease: The constant high-pressure flow of blood damages the delicate inner lining of the blood-vessels. Small tears develop in this lining. Fat from the food consumed enters the blood-stream and flows through the coronary arteries. Over time, some of this fat starts depositing in the tears of the arteries. Gradually, the deposits increase, thereby narrowing down the artery. Narrowed arteries means reduced blood-flow to the tissues of the heart, and hence reduced supply of oxygen. This leads to chest-pain (called angina), irregular heart-beat (called arrhythmias) and possible heart-attack.
• Heart Failure:The increased blood-pressure reduces the pumping power of the heart. Rather, the normal pumping power is not enough to overcome the higher pressure. So, the muscles of the heart stretch in order to allow smoother blood-flow. Over time, this weakens the muscles of the heart and they lose their elasticity. The combination of high blood-pressure and weakened muscles overwhelms the heart and it starts to fail gradually.
• Enlarged left ventricle: As mentioned above, the heart works harder to overcome the reduced pumping power due to hypertension. This causes the walls of the muscles in the left ventricle (which is the main pumping chamber of the heart) to thicken and enlarge over time. This condition is called Left Ventricular Hypertrophy (LVH) and this increases the risk of heart attack and heart failure.

Symptoms of HHD

• Chest pain (angina)
• Shortness of breath (dyspnoea)
• Palpitations and sweaty palms
• Dizziness
• Fainting (syncope)
• Brain stroke(especially Transient Ischemic Stroke)
• Sudden cardiac death (due to electrical malfunctions in the heart)

Risk-factors for HHD

• High blood-pressure
• Sedentary lifestyle with inadequate exercise
• Type-2 diabetes
• High cholesterol in the blood (especially more of bad cholesterol or LDL)
• Age: being older than 45 years of age
• Gender: Men and post-menopausal women are more at risk than pre-menopausal women
• Obesity or being overweight
• Smoking or use of tobacco products in different forms
• Consuming a diet high in salt
• Frequent alcohol consumption

Complications from HHD

• Arrhythmias or irregular heart-beat, especially Atrial fibrillation
• Congestive heart failure
• Coronary artery disease (CAD is both cause of and complication from HDD- because it’s a gradual and ongoing process)
• Atherosclerosis or hardening of the walls of the blood-vessels due to calcification and plaque deposits
• Retinal disease, which is one form of damage to the eyes
• Peripheral arterial disease due to reduced blood-flow in the extremities of limbs, especially the lower leg
• Chronic kidney disease (CKD)
• Aortic aneurysm (the aorta develops a sudden bulge in the outer wall which has got weakened due to HDD. The bulge fills up with blood soon)
• Cerebrovascular disease

Diagnosis

• Blood tests
• Urine test
• Electrocardiogram
• Echocardiogram (for some people)
• Coronary angiography
• Exercise stress test
• Nuclear stress test

Treatment 

 A. Treating the Risk Factors such as 

• High blood pressure (through medication and lifestyle changes)
• Diabetes (through medication and lifestyle changes)
• Obesity (through exercise and dietary changes)
• Lung disease (through medication)
• Sleep apnoea (through various therapies)
• Chronic kidney disease (through medication and other means)
• High cholesterol (through medication and changes to the diet)

B. Lifestyle changes 

• Cessation of smoking and the use of tobacco products
• Reduced alcohol consumption
• Totally stopping the use of recreational drugs
• Exercising more
• Consuming a low-salt diet
• Losing weight through exercise and dietary changes

C. Medication  

• Vasodilators: These help the blood-vessels become wider
• Diuretics: These help the body get rid of excess fluid
• Renin inhibitors, Angiotensin II receptor blockers and Angiotensin-converting enzyme inhibitors: These drugs help relax the blood-vessels
• Calcium channel blockers:  these make the blood vessels open wider
• Beta blockers: these slow-down the heart rate and reduce the strain on the heart

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801

Updated on 10^th Feb 2024