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Introducing the Concept of Hypertensive Heart Disease to Improve Hypertensive Left Ventricular Hypertrophy
Goran Koracevic1,2, Milovan Stojanovic2,3, Marija Zdravkovic4
1Department of Cardiovascular Diseases, University Clinical Center Niš, Niš, Serbia.
Insights
Hypertensive heart disease (HHD) is a more comprehensive concept than left ventricular hypertrophy (LVH) for hypertension-induced cardiac damage. Current hypertension guidelines inadequately address HHD, missing crucial therapeutic implications.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Guidelines
Background:
- Hypertension (HTN) frequently leads to cardiac damage, with hypertensive heart disease (HHD) being a significant concern.
- Current focus often remains on left ventricular hypertrophy (LVH) as the primary indicator of cardiac damage, potentially overlooking broader cardiac involvement.
Purpose of the Study:
- To review the integration of the hypertensive heart disease (HHD) concept within existing hypertension (HTN) guidelines.
- To explore the potential benefits of incorporating HHD into future research and clinical practice if it is currently underrepresented.
Main Methods:
- A comprehensive literature search was conducted across major scientific databases (Scopus, Medline, Springer, etc.).
- The search focused on hypertension guidelines, specifically identifying references to 'hypertensive heart disease'.
Main Results:
- The concept of hypertensive heart disease (HHD) offers a more complete understanding of cardiac damage compared to isolated left ventricular hypertrophy (LVH).
- HHD was explicitly mentioned in only 8 out of 36 reviewed hypertension guidelines.
- Therapeutic implications and specific recommendations regarding HHD were largely absent from the analyzed guidelines.
Conclusions:
- Hypertensive heart disease (HHD) is a valid, evidence-based concept that should be prioritized over focusing solely on left ventricular hypertrophy (LVH).
- Recommendations for treating hypertension-induced cardiac damage should be updated to 'Treatment of Hypertensive Heart Disease' instead of 'Treatment of Hypertensive LVH'.
- Adopting the HHD framework can improve clinical awareness and management of all aspects of cardiac damage caused by hypertension.
Background:
Among the organ damage mediated by hypertension, cardiac lesions hold significant importance. Numerous authors focus on hypertensive heart disease (HHD) rather than exclusively on left ventricular hypertrophy (LVH).
Objectives:
This narrative review aims to assess the incorporation of the concept of 'hypertensive heart disease' (HHD) in hypertension (HTN) guidelines. Furthermore, if HHD is not addressed, the review will evaluate the potential benefits of including this concept in future studies.
Methods:
The following databases were searched: Scopus, Medline, Springer, Science Direct, Wiley, SAGE, Cambridge, Oxford Journals, and Google Scholar. Attention was given to the guidelines related to hypertension (HTN); the search items were "guidelines" and "hypertension." Within these guidelines, we specifically sought references to 'hypertensive heart disease.'.
Results:
The concept of "HHD" is clearly advantageous compared to "HTN LVH," as it not only addresses LVH but also considers other structures of the heart that may be severely affected, which can significantly influence treatment. The concept of "hypertensive heart disease" is mentioned in only 8 out of 36 guidelines on HTN. The therapeutic implications and recommendations are absent in the guidelines.
Conclusion:
The concept of HHD is reasonable and evidence-based, and there is no reason to focus only on LVH when considering HTN-induced damage to the heart. It is time to update our recommendations for heart treatment by using the phrase "Treatment of hypertensive heart disease" instead of "Treatment of hypertensive LVH." This update can enhance our awareness of the need to improve not only HTN LVH but the other parts of the heart as well.
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