The Progression of Hypertensive Heart Disease

ypertension remains a major public health problem associated with considerable morbidity and mortality.Hypertensive heart disease is a constellation of abnormalities that includes left ventricular hypertrophy (LVH), systolic and diastolic dysfunction, and their clinical manifestations including arrhythmias and symptomatic heart failure.The classic paradigm of hypertensive heart disease is that the left ventricular (LV) wall thickens in response to elevated blood pressure as a compensatory mechanism to minimize wall stress.Subsequently, after a series of poorly characterized events ("transition to failure"), the left ventricle dilates, and the LV ejection fraction (EF) declines (defined herein as "dilated cardiac failure"). 1The purpose of this review is to focus on the key steps in the progression of hypertensive heart disease (Figure 1), highlighting recent advances as well as some unresolved controversies.