International Journal of Clinical Case Reports 2024, Vol.14, No.3, 144-156 http://medscipublisher.com/index.php/ijccr 147 LVH is often accompanied by left atrial enlargement due to the increased pressure needed to fill the stiffened left ventricle. This atrial enlargement predisposes patients to atrial fibrillation (AF), a common arrhythmia in hypertensive patients with LVH. Atrial fibrillation not only worsens symptoms and quality of life but also increases the risk of thromboembolic events such as stroke (Kissima et al., 2018). 2.2.3 Vascular changes and consequences Hypertension also affects the vasculature, leading to structural and functional changes that exacerbate cardiovascular risk. Chronic high blood pressure causes endothelial dysfunction, characterized by a reduced availability of nitric oxide, which is essential for vasodilation. This dysfunction promotes vasoconstriction, inflammation, and atherogenesis, contributing to the development of atherosclerotic plaques (Masenga and Kirabo, 2023). Arterial stiffness is another major consequence of prolonged hypertension. It results from structural changes in the arterial wall, including increased collagen deposition and elastin degradation. Arterial stiffness increases the workload on the heart and is a predictor of cardiovascular events. The increased pulsatile load on the arteries can lead to microvascular damage, particularly in the kidneys and brain, contributing to chronic kidney disease and cognitive decline (Touyz et al., 2018). 2.3 Risk factors and comorbidities Patients with hypertensive heart disease often have comorbid conditions that complicate management and worsen outcomes. Diabetes mellitus and hypercholesterolemia are common in these patients and contribute to accelerated atherosclerosis and increased cardiovascular risk (Jia and Sowers, 2021). These conditions promote endothelial dysfunction, oxidative stress, and inflammation, further impairing cardiovascular function (Saheera and Krishnamurthy, 2020). Family history is a significant risk factor for hypertensive heart disease. Genetic predisposition can influence the severity and progression of hypertension and its cardiovascular complications. Studies have shown that individuals with a family history of hypertension are more likely to develop LVH and other forms of hypertensive heart disease (Benson et al., 2023). Understanding these genetic and familial influences is crucial for risk stratification and the development of personalized treatment strategies. 3 Clinical Presentation and Diagnosis 3.1 Symptoms and signs 3.1.1 Common clinical presentations Hypertensive heart disease (HHD) encompasses a variety of cardiac conditions that arise due to chronic high blood pressure. The symptoms can vary widely depending on the severity of the disease and the extent of cardiac involvement. Common clinical presentations of HHD include dyspnea, which is often the most prominent symptom. Dyspnea occurs due to left ventricular dysfunction and the resulting pulmonary congestion, with patients initially experiencing shortness of breath during exertion, progressing to dyspnea at rest as the disease advances. Fatigue is another common symptom, resulting from reduced cardiac output and poor perfusion of the tissues, significantly impacting a patient’s quality of life and daily activities. Chest pain or angina may also be present, as hypertension can lead to coronary artery disease and myocardial ischemia, presenting as chest pain or discomfort often relieved by rest. Additionally, patients with HHD may experience palpitations due to arrhythmias, which are common in this condition. Atrial fibrillation, in particular, is prevalent and can exacerbate symptoms of heart failure (Kissima et al., 2018). Edema, particularly in the legs and ankles, can occur due to right-sided heart failure or severe left-sided heart failure with secondary pulmonary hypertension. Some patients may also present with syncope or dizziness, arising from reduced cardiac output, severe arrhythmias, or cerebrovascular complications associated with hypertension. The insidious nature of hypertension means that many patients may not exhibit symptoms until significant cardiac damage has occurred.
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