Wednesday, February 1, 2023

Hypertension And Heart Failure

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About Author: Ken Harris

Hypertension and heart damage | Circulatory System and Disease | NCLEX-RN | Khan Academy

Ken Harris is the proudest father and a writing coordinator for the Marketing & Communications division of OSF HealthCare.He has a bachelor’s in journalism from the University of Wisconsin-Madison and worked as a daily newspaper reporter for four years before leaving the field and eventually finding his way to OSF HealthCare.In his free time, Ken likes reading, fly fishing, hanging out with his dog and generally pestering his lovely, patient wife.

Cardiovascular Effects Of Hypertension

Uncontrolled and prolonged elevation of BP can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart. These changes in turn can lead to the development of left ventricular hypertrophy , coronary artery disease , various conduction system diseases, and systolic and diastolic dysfunction of the myocardium, complications that manifest clinically as angina or myocardial infarction, cardiac arrhythmias , and congestive heart failure .

Thus, hypertensive heart disease is a term applied generally to heart diseases, such as LVH , coronary artery disease, cardiac arrhythmias, and CHF, that are caused by the direct or indirect effects of elevated BP. Although these diseases generally develop in response to chronically elevated BP, marked and acute elevation of BP can lead to accentuation of an underlying predisposition to any of the symptoms traditionally associated with chronic hypertension.

The following conditions should also be considered when evaluating hypertensive heart disease:

  • Coronary artery atherosclerosis

  • Congestive heart failure due to other etiologies

  • Atrial fibrillation due to other etiologies

  • Diastolic dysfunction due to other etiologies

Epidemiology Of Hhf In Asia

Most of the HF epidemiologic data up to date came from Europe and North America . There are few data on the epidemiology of HF or the relationship between HF and HT in Asia. In Korea, the prevalence of HF among general population was reported as 1.53% . However, the prevalence continuously increased approximately 2 folds from 2002 to 2013. The prevalence of HF in Taiwan and China was reported as 6% and 1.3% , respectively. The prevalence of HF in Japan was relatively low than in other Northeast Asia regions . The prevalence of HF in Southeast Asia showed variable prevalences such as 5% in Indonesia, 0.4% in Thailand, and 12%, in the Philippines .

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High Blood Pressure And Hypertensive Crisis

If your blood pressure readings exceed 180/120 mm Hg and you have any symptoms such as headache, chest pain, nausea/vomiting or dizziness, call 911 immediately. If you dont have any symptoms, wait five minutes and then test your blood pressure again.

Also contact your health care professional immediately if your readings are still unusually high and you arent experiencing any other symptoms of target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision or difficulty speaking. You could be experiencing a hypertensive crisis.

Hypertension As A Risk Factor For Hf

Hypertensive Heart Disease Vs Cad

The original Framingham study data identified hypertension as the major risk factor for HF. A more recent report from the Framingham study, which also identified hypertension as the most common risk factor for HF, showed in a multivariate analysis that hypertension was associated with 39% of cases of HF in men and 59% in women and with a two- to threefold increased risk for HF after adjusting for age and other risk factors. This study also underscores the importance of the interaction of hypertension with other risk factors in predicting the prognosis of HF . In hypertensive subjects, myocardial infarction, diabetes, left ventricular failure, and valvular heart disease were all predictive of significantly greater risk for HF.

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What Do Blood Pressure Numbers Mean

Blood pressure is measured using two numbers:

The first number, called systolic blood pressure, measures the pressure in your arteries when your heart beats.

The second number, called diastolic blood pressure, measures the pressure in your arteries when your heart rests between beats.

If the measurement reads 120 systolic and 80 diastolic, you would say, 120 over 80, or write, 120/80 mmHg.

Treatment Of Left Ventricular Systolic Dysfunction

Diuretics are used in the treatment of LV systolic dysfunction. Low-dose spironolactone has been shown to decrease the rates of morbidity and mortality in patients in NYHA class III or IV heart failure who are already taking ACE inhibitors. This agent is also recommended for use in post-myocardial infarction patients with diabetes mellitus or who have an LV ejection fraction of less than 40%.

ACE inhibitors or angiotensin receptor blockers are used for preload and afterload reduction and the prevention of pulmonary or systemic congestion. These drugs have been shown to decrease morbidity and mortality rates in patients with heart failure due to systolic dysfunction. The aim should be to use the target dose or the maximum tolerable doses. ACE inhibitors are also indicated in patients with asymptomatic LV dilatation and dysfunction.

The angiotensin receptor neprilysin inhibitor sacubitril/valsartan has been shown to be superior to ACE inhibitor alone in reducing the risk of death and hospitalization in patients with heart failure due to systolic dysfunction and is now preferred over ACE Inhibitots and ARBs.

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Treatment Of Hypertension In Patients With Heart Failure: The J

The relationship between BP and the HF prognosis is not necessarily always linear. A J-curve that is similar to that which describes the relationship between the BP and CV outcomes, has been indicated repeatedly in patients with HTN . The findings from a study of the KorAHF registry showed that a reverse J-curve relationship was evident between the treatment of BP and the outcomes of patients who were hospitalized for HF , and that the risks of mortality and readmission increased at low and high BPs, with similar trends for patients with HFrEFs and HFpEFs .

Restricted Cubic Splines Model for All-Cause Mortality According to On-Treatment BP. a SBP: all population. b SBP: heart failure with reduced ejection fraction . c SBP: heart failure with preserved EF. d DBP: all population. e DBP: heart failure with reduced EF . f DBP: heart failure with preserved EF. SBP, systolic blood pressure DBP, diastolic blood pressure. Reprinted from JACC: Heart Failure, Vol 5, Lee SE, et al., Reverse J-Curve Relationship Between On-Treatment Blood Pressure and Mortality in Patients With Heart Failure, 810819 No.11, 2017, with permission from Elsevier

Choice Of Treatment For Hypertension And Hf

Cardiac | Hypertension (HTN)

Diuretics have been used in the treatment of hypertension and HF for a long time. They reduce plasma volume and central venous pressure, and thus lower preload. Overt pulmonary congestion is best treated by diuretics, and diuretics are mandatory when pulmonary congestion is severe. However, there are concerns about a more general role for diuretics, as they activate the RAAS. As yet, they have not been investigated in a controlled, double-blind trial with prognostic end points, and accordingly the use of diuretics for the long-term treatment of HF is viewed with caution by some.

Vasodilators were first used for the treatment of HF by Majid et al about 25 years ago. Dyspnea in patients with HF may be treated by improving cardiac output and pulmonary perfusion via systemic vasodilatation. The physiology of HF in response to declining cardiac output is, however, characterized not only by systemic vasoconstriction, but also by neurohumoral activation. ACE inhibitors are the only antihypertensive agents capable of reversing both of these homeostatic abnormalities, and are among the few agents that produce consistent and symptomatic improvement in patients with HF.

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Exercise Response In Patients With Diastolic Heart Failure

At rest, patients with diastolic heart failure have similar end-diastolic and stroke volumes as healthy individuals. However, due to the decreased LV compliance in this population, the increase in LV filling pressure induced by exercise is not accompanied by increases in end-diastolic volume due to an inability to use the Frank-Starling mechanism . Moreover, an abnormal relaxationâheart rate relationship prevents augmentation of relaxation velocity as heart rate increases during exercise in patients with diastolic heart failure. Surprisingly, exercise limitations in patients with heart failure cannot always be attributed to diastolic abnormalities, as exercise capacity was observed to correlate with changes in cardiac output, heart rate and vascular resistance but not end-diastolic or stroke volume . A small trial showed that angiotensin II receptor antagonists improve exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise .

Testing And Diagnosis: When To See The Doctor

Your doctor will review your medical history, conduct a physical exam, and run lab tests to check your kidneys, sodium, potassium, and blood count.

One or more of the following tests may be used to help determine the cause of your symptoms:

  • Electrocardiogram monitors and records your hearts electrical activity. Your doctor will attach patches to your chest, legs, and arms. The results will be visible on a screen, and your doctor will interpret them.
  • Echocardiogram takes a detailed picture of your heart using ultrasound.
  • Coronary angiography examines the flow of blood through your coronary arteries. A thin tube called a catheter is inserted through your groin or an artery in your arm and up into the heart.
  • Exercise stress test looks at how exercise affects your heart. You may be asked to pedal an exercise bike or walk on a treadmill.
  • Nuclear stress test examines the flow of blood into the heart. The test is usually conducted while youre resting and exercising.

Treatment for hypertensive heart disease depends on the seriousness of your illness, your age, and your medical history.

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What Is High Blood Pressure

High blood pressure, also called hypertension, is blood pressure that is higher than normal. Your blood pressure changes throughout the day based on your activities. Having blood pressure measures consistently above normal may result in a diagnosis of high blood pressure .

The higher your blood pressure levels, the more risk you have for other health problems, such as heart disease, heart attack, and stroke.

Your health care team can diagnose high blood pressure and make treatment decisions by reviewing your systolic and diastolic blood pressure levels and comparing them to levels found in certain guidelines.

The guidelines used to diagnose high blood pressure may differ from health care professional to health care professional:

  • Some health care professionals diagnose patients with high blood pressure if their blood pressure is consistently 140/90 mm Hg or higher.2 This limit is based on a guideline released in 2003, as seen in the table below.
  • Other health care professionals diagnose patients with high blood pressure if their blood pressure is consistently 130/80 mm Hg or higher.1 This limit is based on a guideline released in 2017, as seen in the table below.
systolic: 130 mm Hg or higherdiastolic: 80 mm Hg or higher

If you are diagnosed with high blood pressure, talk with your health care team about your blood pressure levels and how these levels affect your treatment plan.

Brigette Thompson: This Is My Pah Story

Hypertension and Congestive Heart Failure

Every day that I wake up is a good day because I am still here.

It all started one morning in 2011 when I went to work. I parked in the parking structure on the first level. I got to the elevator with my work cart. I pushed the button, but nothing happened. I waited and waited and waited. Still nothing. As I stood there trying to figure out what I was going to do , a man came from nowhere. He picked up my cart, ran up the stairs and was far away by the time I got up the stairs. I yelled gasping for breath, Thank you! He said he had to run, that he was on C shift and had to clock in.

I knew there was something wrong with me. Never in my life could I not walk or even run up a flight of stairs, even with the cart.

My symptoms presented like asthma. I had shortness of breath and tired very easily. I would get on the treadmill and couldnt do what I used to do. I told one of my doctors, and he said, Youre probably just out of shape. I said No, this is different.

So, I went to my pulmonologistI already had one because I have lots of allergiesand he tested me for asthma. I did not have asthma. He tested me for several things. I did not have any of them. He said, Im running out of things to test you for. Theres only one thing left you probably dont have it because it is so very rare. I was fortunate this process with my pulmonologist only took a few months.

Limiting my fluid intake was just the beginning of a modified lifestyle that I am still adjusting to.

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Open Access License / Drug Dosage / Disclaimer

This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License . Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor. The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

High Blood Pressure Threatens Your Health And Quality Of Life

In most cases, damage done from high blood pressure occurs over time. Left undetected or uncontrolled, high blood pressure can lead to:

  • Heart attack High blood pressure damages arteries that can become blocked and prevent blood flow to the heart muscle.
  • Stroke High blood pressure can cause blood vessels that supply blood and oxygen to the brain to become blocked or burst.
  • Heart failure The increased workload from high blood pressure can cause the heart to enlarge and fail to supply blood to the body.
  • Kidney disease or failure High blood pressure can damage the arteries around the kidneys and interfere with their ability to filter blood effectively.
  • Vision loss High blood pressure can strain or damage blood vessels in the eyes.
  • Sexual dysfunction High blood pressure can lead to erectile dysfunction in men and may contribute to lower libido in women.
  • Angina Over time, high blood pressure can lead to heart disease including microvascular disease . Angina, or chest pain, is a common symptom.
  • Peripheral artery disease Atherosclerosis caused by high blood pressure can lead to narrowed arteries in the legs, arms, stomach and head, causing pain or fatigue.

Download the consequences of HBP infographic: English | Spanish | Traditional Chinese

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Hannah: Living With High Blood Pressure

While research looks to understand why high blood pressure happens, physicians like Dr. John White are working to manage these patients on an individual basis

Hypertension, or high blood pressure, affects one out of every three American adults over the age of 18, and for about half of these, the blood pressure is uncontrolled.

Still, the reason its called a silent killer is because those who are affected dont necessarily feel symptoms, unless blood pressure pushes to dangerous levels.

Hannah Massey lived on that edge for about five years.

And it all started when she was just 18 years old.

No big deal

My mom had high blood pressure, and her father had high blood pressure, said Massey, a native of Lexington, South Carolina. It was just one of those things they went to the doctor for. It runs in the family. My grandfather had been on blood pressure medicine since he was 22, and my mom had been on medicine since she was 35 years old, and it was controlled all that time.

So when the high school senior and active cheerleader went in for her pre-school year physical, and the doctor said, Its a little high. She didnt think much about it. It was just, You have high blood pressure’no big deal.

During college at the University of South Carolina at Columbia, her primary care physician began putting her on this medication, then that, in the search to find one that would control her still erratic pressure levels.

She was 22 years old.

Your Best Protection Is Knowledge Management And Prevention

Hypertension effects on the heart | Health & Medicine | Khan Academy

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Guanylyl Cyclases In Ph

Most studies investigating the effect of guanylyl cyclases in PH-LHD did not show a proven benefit. In the Left Ventricular Systolic Dysfunction Associated With Pulmonary Hypertension Riociguat Trial study, the riociguat group showed no difference in mPAP compared with the placebo in patients with PH-HFpEF, although there was an improvement in PVR, cardiac index, and the stroke volume index .41) The Acute Hemodynamic Effects of Riociguat in Patients with Pulmonary Hypertension Associated with Diastolic Heart Failure study also demonstrated that riociguat treatment did not improve mPAP.42) Another trial investigating riociguat, the Pharmacodynamic Effects of Riociguat in Pulmonary Hypertension and Heart Failure with Preserved Ejection Fraction trial is currently underway to validate the effects of riociguat on the improvement of cardiac output in PH-HFpEF patients. Vericiguat was also investigated in both HFrEF43) and HFpEF patients,44) but the results showed that vericiguat was not associated with benefit in terms of natriuretic peptide levels or LA volume compared with the placebo group .

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