International Journal of Clinical Case Reports 2024, Vol.14, No.3, 144-156 http://medscipublisher.com/index.php/ijccr 148 3.1.2 Diagnostic criteria and initial evaluation The diagnosis of HHD involves a thorough clinical assessment, including history taking, physical examination, and diagnostic tests. The initial evaluation focuses on identifying the presence and impact of hypertension and detecting any cardiac changes. A detailed patient history is essential to identify symptoms suggestive of HHD, assess the duration and control of hypertension, and uncover any associated risk factors or comorbidities such as diabetes, hyperlipidemia, or chronic kidney disease. During the physical examination, clinicians look for physical signs of HHD, which can include an elevated blood pressure reading, displaced apical impulse indicating left ventricular hypertrophy (LVH), and the presence of a fourth heart sound (S4) due to reduced ventricular compliance. Additional findings may include peripheral edema, jugular venous distension, and hepatomegaly in cases of right-sided heart failure. Accurate measurement of blood pressure is crucial in diagnosing and managing hypertension, with both office and home blood pressure readings used to confirm sustained hypertension (Westaby et al., 2021). Electrocardiography (ECG) is a fundamental tool in the initial assessment of HHD, revealing signs of LVH, left atrial enlargement, and arrhythmias such as atrial fibrillation. Specific criteria like the Sokolow-Lyon index are used to diagnose LVH. Echocardiography remains the gold standard for evaluating cardiac structure and function in HHD, providing comprehensive information about ventricular size, wall thickness, and function. Doppler echocardiography can assess diastolic function, which is often impaired in HHD. Advanced echocardiographic techniques, such as strain imaging, can detect subclinical myocardial dysfunction before the appearance of overt symptoms. Laboratory tests, including measurements of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP), can aid in diagnosing and prognosticating HHD. Renal function tests, lipid profiles, and blood glucose levels are also evaluated to identify comorbid conditions. 3.2 Diagnostic methods 3.2.1 Role of imaging and biomarkers Imaging plays a crucial role in the diagnosis and management of HHD. Techniques such as echocardiography and cardiac magnetic resonance imaging (MRI) provide detailed insights into cardiac structure and function. Echocardiography is widely used to detect LVH, evaluate systolic and diastolic function, and identify other cardiac abnormalities. Cardiac MRI offers superior tissue characterization and can detect myocardial fibrosis, a key feature of HHD that is associated with adverse outcomes. Biomarkers such as B-type natriuretic peptide (BNP) and high-sensitivity cardiac troponin can also aid in diagnosing and prognosticating HHD. 3.2.2 Electrocardiography and echocardiography Electrocardiography (ECG) is a fundamental tool in the initial assessment of HHD. It can detect LVH, left atrial enlargement, and other arrhythmias that are common in hypertensive patients. Specific ECG criteria, such as the Sokolow-Lyon index, are used to diagnose LVH. However, ECG has limitations in sensitivity and specificity compared to imaging modalities (Ayoola et al., 2019). Echocardiography remains the gold standard for evaluating structural heart changes in HHD. It provides comprehensive information about ventricular size, wall thickness, and function. Doppler echocardiography can assess diastolic function, which is often impaired in HHD. Advanced echocardiographic techniques, such as strain imaging, can detect subclinical myocardial dysfunction before the appearance of overt symptoms (Saeed et al., 2020). 4 Long-term Management Strategies 4.1 Pharmacological interventions 4.1.1 Antihypertensive medications The cornerstone of managing hypertensive heart disease (HHD) involves the use of antihypertensive medications to control blood pressure and prevent further cardiovascular damage. Commonly prescribed antihypertensives include ACE inhibitors, beta-blockers, calcium channel blockers, and diuretics. These medications work by different mechanisms to lower blood pressure and reduce the heart's workload, ultimately preventing complications such as left ventricular hypertrophy and heart failure (Tasic et al., 2020).
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