Hypertensive heart disease. A complex syndrome or a hypertensive 'cardiomyopathy'?

Hypertension is a major risk factor for cardiovascular morbidity and mortality. The presence of hypertension more than doubles the risk for coronary heart disease, including acute myocardial infarction and sudden death, and more than triples the risk of congestive heart failure as well as strokes. Patients with high blood pressure frequently have abnormalities of cardiac structure or function, including left ventricular hypertrophy, systolic and diastolic dysfunction and in extreme cases, overt heart failure. There may also be concomitant or related coronary heart disease and an increased risk of arrhythmias and sudden death. Many of these factors are inter-related and their individual contributions are difficult to quantify. There is, however, some debate as to whether ‘hypertensive cardiomyopathy’ exists as a separate entity specific to hypertension. The term ‘cardiomyopathy’, however, would normally be reserved for intrinsic myocardial disease, where underlying causes such as hypertension and coronary artery disease have been excluded. Therefore, the preferred term should perhaps be ‘hypertensive heart disease’, and given the many mechanisms by which the heart may be abnormal in hypertension, the term ‘hypertensive heart disease’ is probably not so controversial. The purpose of this review is to describe the various mechanisms whereby the heart is abnormal in hypertension and to discuss the possibility of a discrete entity called hypertensive cardiomyopathy.