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Pathophysiology of Hypertensive Heart Disease: Beyond Left Ventricular Hypertrophy

  • Hypertension and the Heart (B Upadhya, Section Editor)
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Abstract

Purpose of Review

Given that the life expectancy and the burden of hypertension are projected to increase over the next decade, hypertensive heart disease (HHD) may be expected to play an even more central role in the pathophysiology of cardiovascular disease (CVD). A broader understanding of the features and underlying mechanisms that constitute HHD therefore is of paramount importance.

Recent Findings

HHD is a condition that arises as a result of elevated blood pressure and constitutes a key underlying mechanism for cardiovascular morbidity and mortality. Historically, studies investigating HHD have primarily focused on left ventricular (LV) hypertrophy (LVH), but it is increasingly apparent that HHD encompasses a range of target-organ damage beyond LVH, including other cardiovascular structural and functional adaptations that may occur separately or concomitantly. HHD is characterized by micro- and macroscopic myocardial alterations, structural phenotypic adaptations, and functional changes that include cardiac fibrosis, and the remodeling of the atria and ventricles and the arterial system. In this review, we summarize the structural and functional alterations in the cardiac and vascular system that constitute HHD and underscore their underlying pathophysiology.

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Funding

This work is supported by contracts N01-HL25195 and HHSN268201500001I from the National Heart, Lung, and Blood Institute (NHLBI) and NIH grants HL080124, HL071039, HL077447, HL107385, 1R01HL126136, 5R01HL107385, 1R01HL60040, 1RO1HL70100, R01HL131532, and R01HL134168 (Ramachandran Vasan). Ramachandran S. Vasan is also supported in part by the Evans Medical Foundation and the Jay and Louis Coffman Endowment from the Department of Medicine, Boston University School of Medicine.

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  1. Ronin Institute, Montclair, NJ, USA

    Chike C. Nwabuo

  2. Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA, 01702, USA

    Ramachandran S. Vasan

  3. Departments of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Ramachandran S. Vasan

  4. Department of Medicine, Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine, Boston University Schools of Medicine, Boston, MA, USA

    Ramachandran S. Vasan

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Nwabuo, C.C., Vasan, R.S. Pathophysiology of Hypertensive Heart Disease: Beyond Left Ventricular Hypertrophy. Curr Hypertens Rep 22, 11 (2020). https://doi.org/10.1007/s11906-020-1017-9

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