Early recognition and treatment of hypertensive heart disease

Hypertension leads to left ventricular hypertrophy, diastolic dysfunction, and eventually clinical heart failure (hypertensive heart disease). There is an important need for physicians to recognize this entity, understand its pathophysiology, and become fluent in treatment options available. This review of recent basic science and clinical data serves to accomplish this task.

In the past year, a number of exciting concepts have come to the forefront. First, data on the use of brain natriuretic peptide as a screening biomarker has shown promise in patients with symptoms of heart failure. For the earliest detection of structural changes, serum propeptide of procollagen type I, a marker of the deposition of type I collagen in the cardiac interstitium provides a noninvasive way to quantify myocardial fibrosis. Treatment options in the past few years have focused heavily on the anti-fibrotic effects of inhibitors of the renin-angiotensin-aldosterone system, perhaps supplanting beta blockers as first-line agents to regress left ventricular hypertrophy. The concept of aldosterone escape is discussed, highlighting the importance of aldosterone inhibitors in these patients. Lastly, we provide a comprehensive review of all antihypertensive classes and their effects on hypertensive heart disease.

The incidence of hypertensive heart disease is increasing. Earlier detection may be possible with newly studied serum biomarkers. All anti-hypertensive treatments have shown improvement in regressing left ventricular hypertrophy, but inhibitors of the renin-angiotensin-aldosterone system possess the most potent anti-fibrotic effects. It is increasingly important for clinicians to identify and manage hypertensive heart disease to prevent increased morbidity and mortality.