Pathophysiology of Hypertensive Heart Disease
Left ventricular hypertrophy (LVH) is regarded as the key biomarker of hypertensive heart disease and integrated marker of cardiovascular risk reflecting cardiac alterations induced by hemodynamic and non-hemodynamic factors operating in hypertension. The
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Cesare Cuspidi, Carla Sala, Marijana Tadic, and Guido Grassi
10.1 Introduction A variety of cardiac structural and functional changes, such as increased left ventricular (LV) mass, altered LV geometry, LV dysfunction, left atrial enlargement, aortic root and ascending trait dilatation, reduced coronary reserve, and prolonged ventricular repolarization, have been described in patients with long-standing arterial hypertension [1]. Subtle modifications in LV structure and geometry have been reported in the early phases of essential hypertension and even in prehypertension [2]. Among the manifestations of cardiac damage, most attention has been devoted to LV hypertrophy (LVH), a key biomarker of hypertensive heart disease, highly prevalent in current clinical practice (Fig. 10.1), and associated with systolic and diastolic dysfunction and to increased risk of heart failure and cardiovascular mortality [3].
C. Cuspidi (*) Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy Clinical Research Unit, Istituto Auxologico Italiano IRCCS, Milan, Italy e-mail: [email protected] C. Sala Department of Clinical Sciences and Community Health, University of Milano and Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy e-mail: [email protected] M. Tadic Department of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany G. Grassi Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy IRCCS Multimedica, Sesto San Giovanni, Milan, Italy e-mail: [email protected] © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_10
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40.9
Whole population
43.5
Males
Left Ventricular Hypertrophy
46.2
Females Normal LV Geometry
Fig. 10.1 Prevalence rates of left ventricular hypertrophy according to echocardiographic criteria in systemic hypertension (pooled data from 30 studies, 37,700 participants). Modified by Cuspidi et al. J Hum Hypertens. 2011; Permissions obtained from Springer Nature
Among major cardiovascular diseases, congestive heart failure is nowadays the most common cause of hospitalization in developed countries; its prevalence is progressively increasing worldwide and preceding cerebrovascular and coronary heart disease. Congestive heart failure related to LV diastolic dysfunction is a growing clinical entity involving up to 60% of patients in clinical practice, in particular patients with systemic hypertension and LVH [4]. In this chapter the pathophysiological mechanisms involved in the progression of hypertensive heart disease will be analyzed. In particular, LVH and its subtypes, diastolic and systolic dysfunction, as assessed by imaging techniques, will be discussed in separate subsections.
10.2 Left Ventricular Hypertrophy LVH is a cardinal manifestation of organ damage in patients with systemic arterial hypertension. Clinical and epidemiologica
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