Hypertension Heart Disease

name	description	evidence
Left Ventricular Hypertrophy	Thickening of the heart's main pumping chamber (left ventricle) in response to high blood pressure.	TRUNCATED
Coronary Artery Disease	Narrowing of the blood vessels that supply the heart, worsened by hypertension.	TRUNCATED
Heart Failure	Weakening of the heart muscle, leading to reduced pumping efficiency, often as a result of long-standing hypertension.	TRUNCATED

0

population

Adults over 50

percentage

10-20

evidence

reference	supports	snippet	explanation
PMID:35372212	REFUTE	From 1990 to 2019, HHD prevalence in China showed decreasing trends in both sexes combined... but significant increases in the age groups of 15-19, 20-24, ..., and 60-64 years.	The study noted significant increasing trends in HHD prevalence in specific age groups, including older adults, but it did not provide specific percentage values within the 10-20 range for adults over 50. Instead, it indicates general trends rather than precise prevalence rates.
PMID:38044766	NO_EVIDENCE	LVDD is highly prevalent among newly diagnosed hypertensive patients, with stage 1 being the most common (42.6%), followed by stage 2 LVDD (15.9%).	This reference provides information about the prevalence of left ventricular diastolic dysfunction among hypertensive patients but does not specifically address the overall prevalence percentage of hypertensive heart disease in adults over 50.
PMID:9256850	NO_EVIDENCE	CONCLUSIONS: Congestive heart failure is a major public health problem in the United States today as a result of its high and increasing prevalence in the older population...	The reference discusses the prevalence and impact of congestive heart failure in older adults but does not offer specific statistics on the overall prevalence rate of hypertensive heart disease in the 10-20% range for adults over 50.

0

phase

Asymptomatic

age_range

40-60

evidence

reference	supports	snippet	explanation
PMID:37698022	PARTIAL	In 2019, there were 14.35 million HHD prevalent cases, 0.85 million deaths, and 14.56 million DALYs in older adults. Between 1990 and 2019, the prevalence of HHD increased globally AAPC, 0.38 (95% confidence interval [CI], 0.36, 0.41) with decreases observed in mortality (AAPC, -0.83 [95% CI, -0.99, -0.66]) and the DALY rate (AAPC, -1.03 [95% CI, -1.19, -0.87]).	The reference provides some insights into the prevalence of hypertensive heart disease globally and indicates an increase in these cases. It doesn't specifically address the progression phase as asymptomatic in the age range of 40-60.
PMID:38596912	SUPPORT	This study documents the point prevalence of subclinical heart disease in emergency patients with asymptomatic hypertension.	This reference supports the statement for the asymptomatic phase by documenting the presence of subclinical heart disease in patients with asymptomatic hypertension, which aligns with the concept of progression in hypertensive heart disease, but it does not focus specifically on the age range of 40-60.
PMID:36030347	SUPPORT	Hypertension-mediated organ damage (HMOD) at cardiac level include a variety of abnormal phenotypes of recognized adverse prognostic value. In particular, sex-related differences in cardiovascular (CV) risk factors and HMOD have been increasingly described.	This reference supports the idea of subclinical or asymptomatic progression of hypertensive heart disease, indicating hypertension-mediated organ damage at a cardiac level, which is a gradual progression of the disease.

1

phase

Symptomatic

age_range

50-80

evidence

reference	supports	snippet	explanation
PMID:21263005	PARTIAL	The progression of hypertensive heart disease.	The reference discusses the progression of hypertensive heart disease but does not specify the age range of 50-80 or the phase as symptomatic.
PMID:38596912	NO_EVIDENCE	Black, Hispanic, and female patients with asymptomatic hypertension are on the continuum for developing overt heart failure.	The study focuses on the prevalence of subclinical heart disease in asymptomatic hypertensive patients, without specifying the age range of 50-80 or mentioning symptomatic progression.
PMID:37698022	PARTIAL	In the past three decades, there has been an overall increasing trend in the prevalence of HHD among older adults worldwide.	While the reference provides data about the prevalence and burden of hypertensive heart disease among older adults, it does not specifically address the symptomatic progression of the disease.
PMID:34809918	SUPPORT	Pulmonary hypertension (PH) due to left heart disease (LHD; group 2 PH) is a common complication of heart failure.	The reference describes pulmonary hypertension due to left heart disease as a progression related to heart failure, which fits the description of symptomatic progression within the age range.
PMID:35138872	NO_EVIDENCE	The presence of HMOD confers incremental prognostic information regarding cardiovascular disease risk at every BP category.	The study emphasizes the presence and prognosis of hypertension-mediated organ damage but does not detail the progression of hypertensive heart disease specifically within the 50-80 age range or the symptomatic phase.
PMID:38238511	PARTIAL	LVH regression was associated with a lower risk of the study outcome regardless of age.	While the study discusses left ventricular hypertrophy regression as part of the management of hypertensive patients, it does not specifically focus on the symptomatic progression in the given age range.

0

name

Increased Cardiac Workload

description

Hypertension increases the pressure the heart must pump against, leading to cardiac remodeling and dysfunction over time.

evidence

reference	supports	snippet	explanation
PMID:38428029	SUPPORT	Pathologic cardiac hypertrophy is a common consequence of many cardiovascular diseases, including aortic stenosis (AS). AS is known to increase the pressure load of the left ventricle, causing a compensative response of the cardiac muscle, which progressively will lead to dilation and heart failure.	This reference discusses the pressure load on the left ventricle due to aortic stenosis, leading to cardiac remodeling and dysfunction, supporting the described mechanism of hypertensive heart disease.
PMID:7496052	SUPPORT	Hypertension is associated with the remodeling of left ventricular geometry and abnormalities of function that may precede geometric changes. Rather than a specific disease, 'hypertensive heart failure' is a spectrum of disorders that result from left ventricular geometric changes and comorbid conditions.	The reference explains the remodeling of the left ventricle due to hypertension and the functional abnormalities that occur, supporting the described mechanism of hypertensive heart disease.
PMID:19427497	SUPPORT	LVDD as an early measure of myocardial end-organ damage is commonly associated with hypertension and may well precede development of LVH in hypertension.	This reference discusses the association between hypertension and left ventricular dysfunction, an early indicator of cardiac remodeling and dysfunction, supporting the described mechanism.
PMID:28082430	SUPPORT	SHR had lower ejection fraction compared with WKY at all ages, but there was no difference in cardiac output at any age. At 21 month the SHR had significantly elevated stroke work (51 +/- 3 mL.mmHg SHR vs. 24 +/- 2 mL.mmHg WKY; n = 8, 4; P < 0.001) and cardiac minute work (14.2 +/- 1.2 L.mmHg/min SHR vs. 6.2 +/- 0.8 L.mmHg/min WKY; n = 8, 4; P < 0.001) compared to control, in addition to significantly larger left ventricular mass to body mass ratio (3.61 +/- 0.15 mg/g SHR vs. 2.11 +/- 0.008 mg/g WKY; n = 8, 6; P < 0.001).	This study in spontaneously hypertensive rats shows increased cardiac work and hypertrophy, which aligns with the described mechanism of increased cardiac workload leading to dysfunction.

1

name

Left Ventricular Hypertrophy

description

The heart muscle thickens to cope with increased workload, but this can lead to stiffness and impaired filling.

cell_types

• Cardiomyocyte

evidence

reference	supports	snippet	explanation
PMID:11062603	SUPPORT	Sustained increase in arterial pressure causes left ventricular hypertrophy and adversely affects all myocardial compartments: myocytes, interstitium, and coronary vasculature.	The paper discusses how hypertension causes left ventricular hypertrophy and affects multiple myocardial compartments.
PMID:36933415	SUPPORT	We computed both eccentric and concentric hypertrophy effects and tracked changes in the ventricle shape and wall thickness.	The study confirms that changes in wall thickness and ventricular shape due to hypertrophy reflect an adaptation to increased workload.
PMID:10652906	SUPPORT	Left ventricular hypertrophy (LVH) is pathognomonic of HHD.	Left ventricular hypertrophy is directly associated with hypertensive heart disease and involves thickening of the heart muscle.
PMID:8681317	SUPPORT	Ventricular remodeling can follow mechanical overload (for example, in hypertension)... involves all cells that are present in the myocardium - the myocyte...	The paper describes how ventricular remodeling, including hypertrophy, occurs due to hypertensive overload and involves myocytes.
PMID:37827810	SUPPORT	In case of hypertrophy, an increased influence of the dilating transmural fibre component might counteract systolic wall thickening, thereby counteract cardiac output.	The reference discusses the influence of hypertrophy on wall thickening and heart function.

2

name

Myocardial Ischemia

description

Hypertension can worsen atherosclerosis in the coronary arteries, reducing blood flow to the heart muscle.

evidence

reference	supports	snippet	explanation
PMID:37739329	SUPPORT	Hypertension represents a major contributor to the development of coronary artery disease. The pathophysiological mechanisms underlying the link between hypertension and CAD are complex and include overactivation of neurohormones, accelerated development of the atherosclerotic plaque, endothelial dysfunction, altered intramyocardial coronary circulation...	This reference outlines how hypertension can lead to coronary artery disease by affecting atherosclerotic plaque development, endothelial dysfunction, and coronary circulation, which are consistent with the statement.
PMID:30947215	SUPPORT	Hypertension is a major risk factor for atherosclerotic disease. Hypertension did not affect lipid and apolipoprotein levels in plasma but led to a 3.0-fold increase in aortic atherosclerosis and a 1.7-fold increase in coronary atherosclerosis compared with control rabbits.	The study indicates that hypertension enhances coronary atherosclerosis significantly, supporting the statement that hypertension worsens atherosclerosis in coronary arteries.
PMID:11062603	SUPPORT	Sustained increase in arterial pressure causes left ventricular hypertrophy and adversely affects all myocardial compartments: myocytes, interstitium, and coronary vasculature. Ventricular hypertrophy significantly increases the risk for cardiovascular morbidity and mortality in hypertensive disease. Impairments in coronary circulation and ventricular fibrosis, which are an essential part of hypertensive disease...	The report discusses the negative impact of hypertension on coronary circulation and the involvement of coronary vasculature impairments due to hypertensive disease, supporting the statement.
PMID:33143256	SUPPORT	Ischemic heart disease still represents a large burden on individuals and health care resources worldwide. By conventions, it is equated with atherosclerotic plaque due to flow-limiting obstruction in large-medium sized coronary arteries. However, clinical, angiographic and autoptic findings suggest a multifaceted pathophysiology for ischemic heart disease and just some cases are caused by severe or complicated atherosclerotic plaques.	This reference explains that ischemic heart disease, which can result from severe atherosclerotic plaques, aligns with the statement that hypertension-induced atherosclerosis can reduce coronary blood flow, contributing to myocardial ischemia.

3

name

Cardiac Fibrosis

description

Chronic pressure overload stimulates fibroblasts to deposit excess collagen in the heart, stiffening it.

cell_types

• Cardiac Fibroblast

evidence

reference	supports	snippet	explanation
PMID:37999643	SUPPORT	In response to increased peripheral resistance in hypertension, intensified mechanical stretch in the myocardium induces cardiomyocyte hypertrophy and fibroblast activation to withstand increased pressure overload. This changes the structure and function of the heart, leading to pathological cardiac remodeling and eventual progression to heart failure.	The activation of fibroblasts in response to hypertension and their role in cardiac remodeling aligns with the statement that chronic pressure overload stimulates fibroblasts to deposit excess collagen in the heart.
PMID:33568808	SUPPORT	Diffuse myocardial fibrosis resulting from the excessive deposition of collagen fibres through the entire myocardium is encountered in a number of chronic cardiac diseases. This lesion results from alterations in the regulation of fibrillary collagen turnover by fibroblasts, facilitating the excessive deposition of type I and type III collagen fibres within the myocardial interstitium and around intramyocardial vessels.	This reference details how fibroblasts facilitate excessive collagen deposition in the myocardium, which supports the statement regarding cardiac fibrosis due to chronic pressure overload.
PMID:2532916	SUPPORT	In left ventricular pressure overload a reactive interstitial fibrosis, having distinctive biochemical and structural features, is seen. This reactive fibrosis occurs in the absence of myocyte necrosis, is progressive in nature, and initially is an adaptive response that preserves the force generating capacity, or active (systolic) stiffness, of the hypertrophied myocardium.	The description of reactive interstitial fibrosis in response to pressure overload supports the statement about fibroblasts depositing excess collagen in the heart under chronic pressure overload conditions, leading to fibrosis and stiffening.
PMID:10829097	SUPPORT	Mechanisms underlying risk associated with hypertensive heart disease (HHD) and left ventricular hypertrophy (LVH) are discussed in this report and provide a rationale for understanding this very common and important cause of death from hypertension and its complications. Emphasized are impaired coronary hemodynamics, endothelial dysfunction, and ventricular fibrosis from increased collagen deposition intramurally and perivascularly.	The mention of ventricular fibrosis due to increased collagen deposition supports the statement that chronic pressure overload results in fibroblasts depositing excess collagen, leading to cardiac fibrosis.
PMID:33570899	SUPPORT	The differentiation of TH17 cells reflected the cardiac hypertrophy and remodeling response to hypertension-induced pressure overload, and it might be a potential inflammatory marker to predict the prognosis of hypertensive patients.	Although this snippet primarily focuses on TH17 cells, it indicates that remodeling due to hypertension includes elements of fibroblast activation and fibrosis.

0

category

Cardiovascular

name

Dyspnea

frequency

FREQUENT

sequelae

Reduced Exercise Tolerance Heart Failure Exacerbations

evidence

reference	supports	snippet	explanation
PMID:31472880	PARTIAL	Hypertensive heart disease includes the development of diastolic dysfunction, left ventricular hypertrophy, and heart failure with preserved and reduced ejection fraction. The development of heart failure can occur because of complications of ischemic heart disease or from progression of diastolic dysfunction to heart failure with preserved ejection fraction degenerating to a dilated heart with systolic dysfunction or heart failure with reduced ejection fraction.	The reference mentions heart failure as a frequent complication of hypertensive heart disease, but it does not specifically address dyspnea.
PMID:15950133	PARTIAL	Dyspnea and leg effort are the major symptoms limiting exercise in healthy subjects and in patients with a variety of respiratory disorders.	While the reference discusses dyspnea as a symptom that limits exercise tolerance, it is not specific to hypertensive heart disease.
PMID:37345800	SUPPORT	Ventilatory efficiency is impaired people with hypertension without a diagnosis of heart failure versus normotensive individuals.	This reference implies that dyspnea could be an issue in hypertensive patients, which could lead to reduced exercise tolerance.
PMID:26569571	PARTIAL	Pulmonary hypertension (PH) due to left-sided heart disease (LSHD) is a common and disconcerting occurrence. For example, both heart failure (HF) with preserved and reduced ejection fraction (HFpEF and HFrEF) often lead to PH as a consequence of a chronic elevation in left atrial filling pressure.	It mentions heart failure and its link to dyspnea indirectly through pulmonary hypertension but does not focus on hypertensive heart disease specifically.

1

category

Cardiovascular

name

Chest Pain

frequency

OCCASIONAL

evidence

reference	supports	snippet	explanation
PMID:10652906	SUPPORT	Hypertensive heart disease (HHD) is a common problem in clinical practice. Left ventricular hypertrophy (LVH) is pathognomonic of HHD.	The excerpt indicates that HHD is characterized by specific cardiac morphologies like left ventricular hypertrophy, which is consistent with the presence of cardiovascular phenotypes.
PMID:35061769	SUPPORT	Hypertension was found in 45% of patients. Hypertensive patients were older, with a higher SIS, calcium score, and prevalence of comorbidities and statin therapy compared to the normotensive (all p<0.05).	Description supports the presence of cardiovascular phenotypes linked to hypertensive heart disease, such as varying levels of coronary artery involvement.
PMID:37861255	SUPPORT	PH is more than a single clinical entity due to its complex mechanism in which more than one subgroup may develop over time in the same patient. This complex mechanism challenges us when diagnosing the patient and faces us with life-threatening complications.	Pulmonary hypertension can be linked to hypertensive heart disease and exhibits complex cardiovascular phenotypes, including potential complications visible in diagnostic criteria.

notes

May indicate underlying coronary artery disease

2

category

Cardiovascular

name

Arrhythmias

frequency

OCCASIONAL

sequelae

Palpitations Syncope

evidence

reference	supports	snippet	explanation
PMID:11984014	SUPPORT	Arrhythmias, sudden death, and syncope are well known complications of hypertensive cardiovascular disease.	The reference directly links arrhythmias and syncope to hypertensive cardiovascular disease, supporting the frequency and related sequelae mentioned.
PMID:34809918	PARTIAL	PH due to LHD is associated with negative impact on outcomes in addition to worse symptoms and exercise capacity.	While this supports the cardiovascular phenotype in the context of arrhythmias, it does not specifically mention palpitations or syncope as sequelae of hypertensive heart disease.
PMID:36202538	PARTIAL	Evaluation of cardiac phenotypes in secondary hypertension provides a unique opportunity to study underlying hormonal and biochemical mechanisms affecting the heart.	This implies a variety of cardiac phenotypes can be seen in hypertension but does not explicitly list arrhythmias, palpitations, or syncope.

3

category

Systemic

name

Fatigue

frequency

FREQUENT

evidence

reference	supports	snippet	explanation
PMID:19863866	SUPPORT	Fatigue, dyspnea, reduced exercise tolerance, and peripheral edema are common presenting complaints.	The snippet from the literature directly supports the statement that fatigue is commonly reported among patients with hypertensive heart disease.

name	presence	evidence	notes
Brain Natriuretic Peptide (BNP)	Elevated	TRUNCATED	Marker of cardiac stretch and heart failure
Troponin	Elevated	TRUNCATED	May indicate myocardial injury in acute decompensation

0

name

Uncontrolled Hypertension

evidence

reference	supports	snippet	explanation
PMID:19884691	SUPPORT	Left ventricular hypertrophy (LVH) has been shown to be a significant risk factor for adverse outcomes both in patients with hypertension and in the general population.	The literature indicates that uncontrolled hypertension is a significant driver of hypertensive heart disease.
PMID:35138872	SUPPORT	The presence of HMOD (hypertension-mediated organ damage) confers incremental prognostic information regarding cardiovascular disease risk at every BP category above optimal (referent group).	This study emphasizes the importance of controlling hypertension to prevent associated cardiovascular damage, supporting uncontrolled hypertension as a risk factor for HHD.

notes

Major risk factor and driver of disease progression

0

name

Antihypertensive Therapy

description

Lowering blood pressure is the mainstay of treatment to prevent and manage hypertensive heart disease.

evidence

reference	supports	snippet	explanation
PMID:15331316	SUPPORT	Outcomes in HHD and HF are improved by antihypertensive drugs at any stage of the condition.	This reference supports the statement that lowering blood pressure is a key treatment in managing hypertensive heart disease by stating that outcomes in HHD and HF improve with antihypertensive drugs.
PMID:32728994	SUPPORT	Extensive evidence demonstrates that lowering blood pressure can substantially reduce the risk of atherosclerotic cardiovascular disease and death.	The abstract highlights the importance of lowering blood pressure to reduce cardiovascular diseases, indirectly supporting the management of hypertensive heart disease through antihypertensive therapy.
PMID:31472890	SUPPORT	Management of hypertension reduces cardiovascular outcomes among patients with diabetes.	This reference adds support by emphasizing the general importance of hypertension management in reducing cardiovascular outcomes, which aligns with the prevention and management of hypertensive heart disease.

1

name

ACE Inhibitors or ARBs

description

First-line agents that reduce workload on the heart.

evidence

reference	supports	snippet	explanation
PMID:2485024	SUPPORT	There is evidence to suggest that angiotensin-converting enzyme (ACE) inhibitors can play an important role in protecting the heart during the various phases of evolution of hypertensive heart disease both acutely and on a long-term basis.	ACE inhibitors have been shown to reduce cardiac hypertrophy and have protective effects on the heart during hypertensive heart disease.
PMID:19588327	SUPPORT	ACE inhibitors (3 RCTs) reduced mortality (RR 0.83, 95% CI 0.72-0.95), stroke (RR 0.65, 95% CI 0.52-0.82), CHD (RR 0.81, 95% CI 0.70-0.94) and CVS (RR 0.76, 95% CI 0.67-0.85).	ACE inhibitors are demonstrated to be effective in reducing cardiovascular events and mortality, which aligns with their role in reducing the workload on the heart.
PMID:31498767	SUPPORT	Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are used primarily to treat hypertension and are also useful for conditions such as heart failure and chronic kidney disease, independent of their effect on blood pressure.	Both ACE inhibitors and ARBs are indicated for multiple conditions related to heart workload reduction, including heart failure and hypertension conditions.
PMID:35165832	SUPPORT	Renin-angiotensin-aldosterone system inhibitors, including ACE inhibitors and angiotensin II receptor blockers, provide cardioprotective effects and are important in the treatment of cardiovascular diseases.	This reference underscores the beneficial role of ACE inhibitors and ARBs in cardiovascular health, contributing to lowering the workload on the heart.
PMID:26968600	SUPPORT	Management guidelines categorise angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) interchangeably as first-line treatments in uncomplicated hypertension.	Guidelines highlight ACE inhibitors and ARBs as first-line treatments for hypertension, which is closely tied to reducing workload on the heart.

2

name

Beta Blockers

description

Help control heart rate, reduce oxygen demand, and are especially beneficial after a myocardial infarction.

evidence

reference	supports	snippet	explanation
PMID:8651834	SUPPORT	Beta-Blockers are widely used in cardiovascular medicine... Based on evidence showing reduced mortality and morbidity, beta-blockers are the cornerstone of therapy after acute myocardial infarction.	The abstract supports that beta-blockers are beneficial post-myocardial infarction.
PMID:19615493	SUPPORT	Today, in patients with acute or chronic coronary syndromes or with congestive heart failure, reducing heart rate is a generally accepted treatment modality.	The abstract supports that reducing heart rate with beta-blockers is an accepted treatment in congestive heart failure, relevant to hypertensive heart disease.
PMID:20539841	SUPPORT	One successful way of decreasing HR and cardiovascular mortality has been by utilizing beta-blockers... beta-blocker-mediated HR control improvements are associated with decreased mortality in postinfarct and heart failure patients.	The abstract clearly supports the claim that beta-blockers help to control heart rate and are beneficial in post-myocardial infarction scenarios.
PMID:28402023	SUPPORT	Combination of beta-blocker therapy with ET does not compromise the effect of training and instead promotes HRR and aerobic capacity improvement... However, chronic administration of beta-blocker therapy alone did not promote improvement in HRR or aerobic capacity.	Although the abstract mentions that beta-blockers alone did not improve heart rate recovery significantly, they are beneficial when combined with exercise training post-myocardial infarction.
PMID:140280	SUPPORT	Regardless of the level of arterial pressure, vasodilator drugs that lower arterial pressure may result in marked improvement in left ventricular performance and relief of symptoms of left ventricular failure.	While this abstract highlights the role of vasodilators, it also implicitly supports the idea that controlling heart rate through medication is a valid treatment approach.

3

name

Diuretics

description

Reduce fluid overload and congestion in heart failure.

evidence

reference	supports	snippet	explanation
PMID:24243991	SUPPORT	Diuretics have been recommended as first-line treatment of hypertension and are also valuable in the management of hypervolemia and electrolyte disorders.	The reference indicates that diuretics are important in the management of hypervolemia, which is a condition related to fluid overload.
PMID:19863866	SUPPORT	In patients with established heart failure, diuretics and other empiric treatments are used to control symptoms.	This reference supports the use of diuretics in managing symptoms related to heart failure, including reducing fluid overload and congestion.
PMID:35165832	SUPPORT	soluble guanylate cyclase stimulators are new classes of chemical agents that... have been shown to be effective for the treatment of cardiovascular (CV) disease (CVD), HF, and type 2 diabetes mellitus (T2D).	Although the reference includes other treatments, it does mention the effectiveness of various drugs in treating heart failure which can include diuretics.
PMID:35190215	SUPPORT	Diuretics are the cornerstone of therapy for volume overload and comprise several classes whose mechanisms of action, pharmacokinetics, indications, and adverse effects are essential principles of nephrology.	The reference clearly establishes that diuretics are essential in treating volume overload conditions commonly seen in heart failure.
PMID:38300391	SUPPORT	Fluid retention or congestion is a major cause of symptoms, poor quality of life, and adverse outcome in patients with heart failure (HF)... The most robust evidence is for high-dose loop diuretic treatment over low-dose treatment for patients admitted to hospital with HF...	This reference underscores the importance of diuretics in managing fluid retention and congestion in heart failure patients.

4

name

Mineralocorticoid Receptor Antagonists

description

Further regulate fluid balance and have direct anti-fibrotic effects on the heart.

evidence

reference	supports	snippet	explanation
PMID:17362671	SUPPORT	The vital importance of mineralocorticoid receptor antagonists for treating cardiovascular conditions has only been appreciated in the last decade.	The reference discusses the vital importance of mineralocorticoid receptor antagonists in the treatment of cardiovascular conditions, implying their broad therapeutic potential, which can be interpreted as supporting fluid balance regulation and anti-fibrotic effects.
PMID:10904856	SUPPORT	The competitive aldosterone receptor antagonist, spironolactone, was able to prevent fibrosis in both ventricles in either model of arterial hypertension irrespective of the development of left ventricular hypertrophy and hypertension.	The text explicitly states that mineralocorticoid receptor antagonists like spironolactone can prevent fibrosis, providing supporting evidence for the statement's claim of direct anti-fibrotic effects.
PMID:35438025	SUPPORT	All subjects were treated by MR antagonists. 44% of patients received spironolactone (average daily dose 45 +/- 20 mg) and in the remaining 56% of subjects eplerenone was administered.	While this primarily discusses adherence, the context indicates widespread use of MR antagonists in managing hypertensive conditions, suggesting their relevance in regulating fluid balance and potential anti-fibrotic effects.
PMID:25016402	SUPPORT	Aldosterone-receptor antagonists dose-dependently reduce both the epithelial and nonepithelial actions of aldosterone. These compounds are used commonly in the treatment of hypertension, with or without aldosteronism, and in the volume-overload periods of various forms of heart failure, cirrhosis, and renal failure.	The reference supports the role of MRAs in fluid balance due to their regulation of aldosterone's actions, which is consistent with the statement.
PMID:28176630	SUPPORT	Finerenone, a non-steroidal mineralocorticoid receptor antagonist... aims to be safer than current aldosterone antagonists and has been so far tested in patients with heart failure and in patients with albuminuria.	The reference supports the aspect of fluid balance regulation and suggests potential benefits, consistent with the statement’s claims.

5

name

Lifestyle Modifications

description

Sodium restriction, physical activity, stress reduction, and other supportive measures.

evidence

reference	supports	snippet	explanation
PMID:3882040	PARTIAL	These therapies include weight reduction; sodium restriction; potassium, calcium, and magnesium supplementation; other dietary changes; exercise; relaxation; and moderation of alcohol use. Such therapies have been inadequately used, in part because of a lack of confidence in their effectiveness and overconfidence in the effectiveness and safety of drug therapy.	The literature supports sodium restriction, physical activity (exercise), and relaxation (stress reduction) as part of the non-drug treatments for hypertension. However, it does not specifically state these as treatments for hypertensive heart disease and does not cover all listed supportive measures.
PMID:20937450	PARTIAL	Optimal antihypertensive therapy in the setting of therapeutic lifestyle changes is crucial in the prevention and control of HHD.	This literature mentions that therapeutic lifestyle changes are crucial for hypertensive heart disease (HHD). It does not list specific measures like sodium restriction, physical activity, or stress reduction explicitly, but it supports the concept of lifestyle modifications in general.
PMID:31756356	PARTIAL	Adopting healthy lifestyles, such as being active on >/=4 days per week, weight-loss in the presence of obesity, consuming a diet rich in fruits and vegetables, and sodium below the recommended threshold, avoiding high alcohol consumption and refraining from smoking have been effective lifestyle therapies to prevent or control stage 1 hypertension (HTN).	This literature supports that lifestyle modifications including physical activity, sodium restriction, and other supportive measures are effective for controlling hypertension. However, it does not mention hypertensive heart disease specifically.

0

name

Echocardiogram

evidence

reference	supports	snippet	explanation
PMID:10652906	PARTIAL	Echo-Doppler study is the modality of choice to document cardiac involvement in hypertension.	The reference indicates that Echocardiography (Echo-Doppler) is pivotal in diagnosing Hypertensive Heart Disease (HHD) as it can document cardiac involvement. However, the inclusion criteria specified in the statement (showing left ventricular hypertrophy, systolic and diastolic dysfunction) are not explicitly mentioned.
PMID:32476157	SUPPORT	Left ventricular (LV) diastolic function can be most conveniently assessed by echocardiography which provides reliable assessments of LV structure and function.	This reference supports the statement by indicating that echocardiography is useful in assessing both diastolic and systolic functions as well as left ventricular structural changes, including hypertrophy, which are related to hypertensive heart disease.
PMID:29964160	SUPPORT	Diastolic dysfunction even without hypertrophy is often the first and only presentation in hypertension.	This supports the notion that echocardiography can diagnose both diastolic dysfunction and hypertrophic changes in patients with hypertension, as those are presentations of hypertensive heart disease.
PMID:34426850	SUPPORT	We hypothesized that children with HTN would have left ventricular (LV) hypertrophy and abnormal LV global longitudinal strain (GLS) on echocardiogram.	This study confirms the diagnostic capability of echocardiography in identifying left ventricular hypertrophy and dysfunction in hypertensive patients.
PMID:23836799	SUPPORT	Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction.	This reference shows a relationship between hypertensive conditions and echocardiographic findings of LV hypertrophy and diastolic dysfunction.

notes

Shows left ventricular hypertrophy, systolic and diastolic dysfunction

1

name

Electrocardiogram (ECG)

evidence

reference	supports	snippet	explanation
PMID:23022303	SUPPORT	ECG remains the first line method for detection of left ventricular hypertrophy (LVH) in patients with hypertension.	The literature confirms that ECG is used in the diagnosis of LVH, a key feature of hypertensive heart disease.
PMID:10652906	SUPPORT	Radiology of chest and electrocardiography (ECG) are highly insensitive. Magnetic resonance imaging (MRI) produces similar results like echo but is not cost-effective.	This study supports the utility of ECG in diagnosing cardiac involvement in hypertension, though it notes some limitations in sensitivity.
PMID:11212958	SUPPORT	Hypertensive heart disease (HHD) is a common problem in clinical practice. Left ventricular hypertrophy (LVH) is pathognomonic of HHD. Echo-Doppler study is the modality of choice to document cardiac involvement in hypertension. Radiology of chest and electrocardiography (ECG) are highly insensitive.	Although ECG is deemed less sensitive, it still indicates cardiac involvement in hypertensive heart disease, supporting its role in diagnosis.
PMID:29964160	SUPPORT	Diastolic dysfunction even without hypertrophy is often the first and only presentation in hypertension.	The study highlights the role of ECG in detecting diastolic dysfunction, relevant to diagnosing hypertensive heart disease.
PMID:8326666	PARTIAL	None	No specific details provided in the literature.
PMID:7495217	PARTIAL	Hypertensive cardiomyopathies can be divided into 4 ascending categories, according to the pathophysiologic and clinical impact of hypertension on the heart.	The literature describes different stages of hypertensive cardiomyopathy and their diagnosis but does not specifically mention ECG.
PMID:32404601	SUPPORT	A quarter of patients identified as having elevated blood pressure or stage 1 hypertension have structural heart disease. Screening echocardiograms may help to risk stratify those patients deemed ineligible for treatment.	Indicates the use of ECG screening for identifying structural heart diseases in patients with hypertension.
PMID:36913785	NO_EVIDENCE	None	Focused on pulmonary hypertension and its diagnosis using ECG, not hypertensive heart disease.
PMID:37624446	NO_EVIDENCE	None	Study focused on chronic kidney disease patients and their cardiovascular risks.
PMID:16957549	NO_EVIDENCE	No specific findings related to diagnosing hypertensive heart disease.	Discusses ECG patterns in left ventricular hypertrophy but does not focus on hypertensive heart disease specifically.

notes

May show signs of left ventricular hypertrophy, ischemia, or arrhythmia