Type 2 Diabetes Mellitus Treatment & Management
High Blood Pressure And Hypertensive Heart Disease
Your heart beats around 100,000 times every day. Every minute, it pumps nearly 1.5 gallons of blood. But there are a lot of reasons why this crucial organ can stop working properly. One of those is chronic hypertension, or what you might know as ongoing high blood pressure.
"Hypertensive heart disease is a condition where the heart muscle can get damaged over time due to long-standing high blood pressure," says Joy Gelbman, MD, a cardiologist at Weill Cornell Medicine and New York-Presbyterian. "The heart can become big, thickened or weakened due to pumping against a high blood pressure over a long time."
Keeping your blood pressure under control is critical to managing hypertensive heart disease.
About 1 out of 3 Americans have high blood pressure (higher than 120/80). Only half of these cases are managed well.
You won't be able to feel if blood is pushing against the walls of your arteries with too much force. That's why high blood pressure is sometimes called a "silent killer." But over time, hypertension can make it harder for your heart to pump enough blood. It can also damage or narrow your blood vessels. That can become an even bigger issue if you also have high cholesterol. Cholesterol is a fatty substance that can clog the pathways through which blood flows in your body.
Usually, chronic hypertension happens because of several different factors. These can include:
High blood pressure that isn't treated for a long time can lead to hypertensive heart disease (HTN heart disease.) You could be at a higher risk if:
Hypertension puts extra strain on your heart, which may cause it to weaken and become stiff. Over time, it can begin to fail.
If your arteries become so damaged that enough blood can't reach your heart, you could have a condition called ischemic heart disease (IHD).
You might not have any symptoms until some damage has been done to your heart. The signs of hypertensive cardiovascular disease include:
Your doctor will ask about your family history of heart issues, and check your blood pressure. If you're on medication for high blood pressure, they'll likely ask if you're taking your medication as prescribed and if you are checking your blood pressure at home. If so, your doctor will want to know some of your recent readings.
They'll also ask about any symptoms you're having. During a physical exam, your doctor can listen to your heart. They'll likely also order some tests, including:
"When you're diagnosed with hypertensive heart disease, there are still measures you can take to prevent further complications," says Carmen W. Landrau, MD, a cardiologist and spokesperson for the American Heart Association.
The first step in treating hypertensive cardiovascular disease is treating the high blood pressure that's causing it. That can be done in several ways, including prescribed medications and making small changes to your daily habits.
Medications for hypertensive heart disease
Many different treatments can help manage your blood pressure. They work by relaxing or widening your blood vessels, helping to flush excess fluid from your body, or slowing down your heart rate so your heart doesn't have to work as hard. Your doctor could prescribe:
Lifestyle changes for hypertensive heart disease
Your doctor may also advise you to make changes to your lifestyle. You can:
Make healthy food choices. That includes limiting the amount of sodium and saturated fats you eat. Fill your plate instead with more fruits, vegetables, whole grains, and low-fat dairy.
More physical activity. Working out helps control your blood pressure, maintains your heart function, and helps you reach and stay at a healthy weight.
Avoid tobacco products and alcohol. If you need help quitting, ask your doctor for tips.
Get regular checkups. During follow-up visits, your doctor can make sure you and your heart are staying healthy.
Manage your stress level. Feeling anxious can raise your blood pressure.
Surgeries for hypertensive heart disease
If your condition doesn't get better with medication and lifestyle changes, your doctor may talk to you about a medical procedure.
For instance, an FDA-approved procedure called renal ablation, or renal denervation, helps some people who have resistant hypertension.
During this minimally invasive surgery, a cardiologist uses ultrasound or radiofrequency energy to damage the renal nerves in your kidneys. Making these nerves less active can help control your blood pressure.
Other types of surgeries can help strengthen your arteries or repair or replace damaged parts of your heart. Your doctor can explain which kind of surgery is right for you.
Getting and keeping your blood pressure under control can reduce your chances of more severe heart issues.
Heart failure
Heart failure, or congestive heart failure, doesn't mean your heart stops working. It means that your heart's pumping power is less than it should be. With heart failure, blood doesn't move well through your heart's chambers, and pressure in your heart increases, making it harder for your heart to deliver oxygen and nutrients to your body.
At first, the chambers of your heart will stretch to try to keep blood moving. Your body will also try to adjust in other ways. For instance, your blood vessels will narrow to increase the force of blood flow. And your kidneys will retain more fluid (water) and sodium so there's a larger amount of blood in your body. But these are only short-term fixes.
Symptoms of heart failure include:
Ischemic heart disease (IHD)
When your arteries can no longer open wide enough to easily let blood through, your heart becomes damaged. One of the most common symptoms of ischemic heart disease is chest pain, or what's called angina.
Coronary artery disease (CAD)
This is another name for ischemic heart disease. You could also hear it called coronary heart disease.
Left ventricle hypertrophy (LVH)
High blood pressure makes your heart work harder than it should, which causes its walls to thicken. As a result, the left ventricle (pumping chamber) starts to get stiff and weak. That can prevent enough blood flow, although you may not have symptoms for many years.
Enlarged heart
Your doctor will be able to see this on an imaging test. An enlarged heart isn't a condition. But it is a sign that your heart is working harder than normal or has been damaged.
Stroke
A stroke happens when blood flow to your brain gets blocked. It's a medical emergency because your brain cells can start dying in minutes. Stroke symptoms include having trouble seeing, speaking, walking, or understanding others, numbness on one side of your body, or a sudden, severe headache. If you think you're having a stroke, call 911 right away. Don't wait to see if your symptoms get better or go away on their own.
Sudden cardiac arrest (SCA)
If your heart stops working because of an abnormal heart rhythm, you'll collapse and stop breathing. SCA is different from a heart attack, which happens when blood stops flowing to your heart. CPR can help get your heart started again. An electrical device called an automated external defibrillator (AED) can also shock your heart into pumping again.
To try to prevent hypertensive cardiovascular disease, you can:
Have regular checkups. Your blood pressure should be checked by your doctor at least once a year, more often if it's high.
Take care of any other health conditions. For instance, manage your blood sugar if you live with diabetes. If you know your cholesterol is high, make changes to your eating habits to try to bring it down.
Enjoy healthy meals. Try to eat fewer processed foods, as they're often high in sodium. Instead, look for fresh, flavorful recipes that fit into the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets.
Get moving. When you work out regularly, you can lower your blood pressure by 5 to 8 points. Aim for about 30 minutes of physical activity every day, but even less than that is good for you. Every bit counts.
Quit tobacco and curb your alcohol intake. Doing so could not only lower your risk of hypertensive heart disease but also improve your overall health.
Don't skimp on sleep. Sleeping less than seven hours a night regularly can raise your blood pressure. If you have trouble sleeping, talk to your doctor.
Keep stress in check. You can't get rid of all the stress in your life, but you can get better at dealing with it. If you need new ways to manage stress, a counselor or therapist can help.
When high blood pressure goes untreated for a long time, it can damage your arteries and strain your heart. That can lead to hypertensive heart disease and other complications. While there's no cure, HTN heart disease can be managed with medications and lifestyle changes. See your doctor regularly. That way, they can track your blood pressure and work with you to get it in a healthy range.
How are hypertension heart disease and stroke related?
Most people who have a stroke also have high blood pressure. That's because weakened arteries are more likely to burst or get blocked. Managing your hypertension will help lower your risk of stroke.
What is stage A heart failure?
If you're at risk of heart failure but don't have any symptoms, doctors will say that you're in stage A heart failure. The factors that put you at risk include:
Can hypertensive heart disease be reversed?
Lifestyle choices often play a big role in hypertensive heart disease. You may see your blood pressure numbers improve when you watch what you eat, get regular exercise, quit tobacco use, and manage other ongoing health conditions such as diabetes. It will depend on how severe your condition is, but sometimes heart failure can also be reversed with treatments such as medication or surgery.
Police Confirm Gene Hackman Died Of Hypertensive And Atherosclerotic Cardiovascular Disease
Authorities have released new details concerning Gene Hackman and his wife Betsy Arakawa's deaths over a week since their bodies were found dead in their Santa Fe home (26 February).
In a press conference today (7 March), Santa Fe County Sheriff Adan Mendoza, along with state fire, health and forensics officials, answered a series of questions about the circumstances surrounding the pair's mysterious deaths.
Dr Heather Jarrell, the chief medical examiner, has now confirmed the pair's cause of deaths.
Hollywood actor Gene Hackman and his wife, classical pianist Betsy Arakawa, were found dead in their Santa Fe home last Wednesday (26 February) (Ron Galella, Ltd. / Contributor / Getty Images)She explained that Arakawa, 65, suffered from Hantavirus pulmonary syndrome, adding: "The manner of death is natural.
"Autopsy examination and full body post mortem CT demonstrated no findings of trauma internally or externally with microscopic findings consistent with Hantavirus pulmonary syndrome.
"Laboratory testing was positive for Hantavirus at a clinical lab with required confirmation testing positive at scientific laboratories division, testing for Covid-19, influenza and other common respiratory viruses was negative testing for carbon monoxide was negative.
"There were no other significant natural disease findings, pills present on scene, or thyroid medication which were being taken as prescribed and is not currently a concern for a contributory cause of death."
Dr Jarrell went on to say: "The cause of death for Mr. Gene Hackman, aged 95 years, is hypertensive and atherosclerotic cardiovascular disease, with Alzheimer's disease as a significant contributory factor.
"Autopsy examination and a full body post mortem CT examination demonstrated no acute findings of internal or external trauma and showed severe heart disease, including multiple surgical procedures involving the heart evidence of prior heart attacks and severe changes of the kidneys due to chronic high blood pressure.
"Examination of the brain showed advanced Alzheimer's disease as well as blood vessel changes in the brain secondary to chronic high blood pressure.
"Laboratory testing performed at scientific laboratories division was negative for Covid-19, influenza and other common respiratory viruses, testing for Hantavirus was negative. Testing for carbon monoxide was negative.
"Additionally, there were no autopsy findings concerning for Hantavirus infection."
Officials believe Arakawa died on 11 February, while Hackman is believed to have died a week after.
(Ron Galella, Ltd. / Contributor / Getty Images)Hackman and Arakawa's deaths were previously deemed 'suspicious enough' for investigation, with a search warrant from local police revealing that the couple, who wed back in 1991, had been dead for 'some time' and were found in different rooms after maintenance and security workers showed up at the residence and alerted authorities.
Hackman was found dead in a mudroom - a room designed for dirty or wet footwear and clothing - while Arakawa was found dead in a bathroom.
The couple's dog was found dead in a bathroom closet near Arakawa, while their two other healthy dogs were discovered roaming the property - one inside and one outside.
A sheriff's detective who responded to the scene said they believed the couple had been dead for some time because of Arakawa's 'decomposition' and 'mummification' in the hands and feet.
"The male decedent also showed obvious signs of death, similar and consistent with the female decedent," the search warrant added.
Preliminary findings from a medical investigation also found that the pair suffered 'no external trauma'.
At the time, authorities also confirmed that foul play wasn't suspected, although they hadn't ruled it out.
In a news conference last Thursday afternoon (27 February), Mendoza told reporters: "It sounds like they had been deceased for quite a while, and I don't want to guess in reference to how long that was."
He added: "There was no immediate sign of foul play. Haven't ruled that out yet.
"This is an investigation, so we're keeping everything on the table."
Mendoza also said that Hackman and Arakawa may have died up to two weeks before they were discovered last Wednesday with the Superman actor's pacemaker last showed activity on 17 February - nine days before police were alerted of their deaths.
In an application for a search warrant, Detective Roy Arndt told a judge the circumstances of the couple's death were 'suspicious enough in nature to require a thorough search and investigation' because the person who called emergency services found the front door of the property open.
There was no sign of forced entry into the home with nothing appearing out of place inside.
"There was no indication of a struggle," Mendoza told the media. "There was no indication of anything that was missing from the home or disturbed that would be an indication that there was a crime that had occurred."
PAH Treatment Benefits Extend To Patients With Repaired Congenital Heart Disease
Historical data show the prevalence of pulmonary arterial hypertension (PAH) in adult patients with congenital heart disease ranges from 4% to 28%, according to studies from the US and Europe—and that the prevalence of these comorbid condition is on the rise.
For adults patients with repaired congenital heart disease who are also living with pulmonary arterial hypertension (PAH), medications approved to treat PAH may be as beneficial at reducing morbidity and mortality as they are among the patients who do not have congenital heart disease.
Data demonstrating these clinical treatment conclusions were published in JACC: Advances following a pooled analysis of data from 3 randomized, placebo-controlled studies that investigated what are now currently approved PAH treatments: GRIPHON (NCT01106014), which evaluated selexipag; SERAPHIN (NCT00660179), which evaluated macitentan; and Compass-2 (NCT00303459), which evaluated bosentan and sildenafil vs sildenafil monotherapy.1-4
The prevalence of PAH in adult patients with congenital heart disease varies, with data from the US showing this to be 5% to 10%,5 but increasing6 and data from Europe showing 4% to 28%.7 However, analysis on the impact of treatment for PAH in the setting of congenital heart disease is limited, according to the authors of the present study.1 Their primary end point was time to first confirmed morbidity/mortality.
Of the 1982 patients included in this study, 177 (8.9%) patients had congenital heart disease–associated PAH (CHD-PAH). They had to be at least 1 year (GRIPHON and SERAPHIN) or at least 2 years (Compass-2) post heart repair surgery, have PAH confirmed via right heart catheterization, and a 6-minute walking distance (6MWD) result of at least 50 meters (GRIPHON and SERAPHIN) or 150 meters (Compass-2).
Patient DataPatients in the CHD-PAH group receiving the study drug were younger vs the overall study population (mean [SD] age, 41 [16] vs 48 [15] years), and at baseline, fewer patients had World Health Organization functional class (WHO FC) III disease (39% vs 51%), more patients had WHO FC II disease (60% vs 48%), and the mean 6MWD result was longer, at 379.9 (72.9) vs 362.3 (79.5) meters.
When study investigators looked at death due to PAH or hospitalization due to PAH worsening, the risk reductions were similar: 36% and 31%.Image Credit: © ibreakstock-stock.Adobe.Com
The most common repaired CHDs across the 3 studies were atrial septal defect (52.1%), ventricular septal defect (11.7%), and patent ductus arteriosus (4.6%).
Study ResultsFor morbidity and mortality, fewer patients in the CHD-PAH vs overall the PAH cohort receiving the active drug vs placebo experienced an event, at 17% and 31% vs 31% and 44%. Adjusting for age, sex, and time since diagnosis showed this to be a 50% risk reduction (HR, 0.50; 95% CI, 0.26-0.94) for those with repaired CHD who had PAH and similar to the overall finding among the PAH-alone group (HR, 0.63; 95% CI, 0.53-0.75).
When the investigators also looked at death due to PAH or hospitalization due to PAH worsening, the risk reductions trended similar between the CHD-PAH and overall PAH cohorts: 36% (HR, 0.64; 95% CI, 0.32-1.26) and 31% (HR, 0.69; 95% CI, 0.51-0.92), respectively.
For the secondary end points, under a sensitivity analysis, a similar benefit was seen in 6MWD results from baseline to 6 months in the PAH and CHD-PAH cohorts: 13.4 m (95% CI, 2.1-24.7) and 20.1 m (95% CI, –15.9 to 56.2). When changes in NT-proBNP were evaluated, the ratios of active drug to baseline were 0.76 (95% CI, 0.71-0.81) and 0.92 (95% CI, 0.77-1.10), respectively. And lastly, for worsening of WHO FC, the ORs were 0.84 (95% CI, 0.53-1.33) and 0.99 (95% CI, 0.41-2.37), "indicating no difference," according to the authors.
Hospitalization rates were similar, as well. For those in the overall PAH group, 20.5% of patients receiving the active drug had a PAH-related hospital stay compared with 17.8% in the CHD-PAH group. Annualized incident rate ratios were close to equal, at 1.39 (95% CI, 1.12-1.71) and 1.38 (95% CI, 0.66-2.88), respectively. Total annualized PAH-related hospital days were 15.2 (28.2) vs 8.9 (10.5).
ConclusionsThere was a similar total benefit between the overall PAH and CHD-PAH groups for the primary end point, while the PAH group exhibited statistically significant differences when the secondary end points were considered. However, the magnitude of the treatment effect in the CHD-PAH group was noted to be "generally similar."
The authors noted, "This pooled analysis using data from indicates that there is an improvement in outcomes with PAH therapy in patients with CHD-PAH and provides important evidence to guide medical management of this growing patient population."
References
1. Outcomes in patients receiving treatment for pulmonary arterial hypertension associated with repaired congenital heart disease. JACC Adv. 2025;4(3):101626. Doi:10.1016/j.Jacadv.2025.101626
2. Selexipag (ACT-293987) in pulmonary arterial hypertension (GRIPHON). ClinicalTrials.Gov. Updated February 4, 2025. Accessed March 13, 2025. Https://clinicaltrials.Gov/study/NCT01106014
3. Study of macitentan (ACT-064992) on morbidity and mortality in patients with symptomatic pulmonary arterial hypertension (SERAPHIN). ClinicalTrials.Gov. Updated September 28, 2015. Accessed March 13, 2025. Https://clinicaltrials.Gov/study/NCT00660179
4. Effects of the combination of bosentan and sildenafil versus sildenafil monotherapy on pulmonary arterial hypertension (PAH) (Compass-2). ClinicalTrials.Gov. Updated February 4, 2025. Accessed March 13, 2025. Https://clinicaltrials.Gov/study/NCT00303459
5. Pascall E, Tullok RMR. Pulmonary hypertension in congenital heart disease. Future Cardiol. 2018;14(4):343-353. Doi:10.2217/fca-2017-0065
6. Jone PN, Ivy DD, Hauck A, et al. Pulmonary hypertension in congenital heart disease: a scientific statement from the American Heart Association. Circ Heart Fail. 2023;16(7):e00080. Doi:10.1161/HHF.0000000000000080
7. D'Alto M, Mahadeva VS. Pulmonary arterial hypertension associated with congenital heart disease. Eur Respir Rev. 2012;21(126):328-337. Doi:10.1183/09059180.00004712
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