HEART IN HYPERTENSION - Dr. Aparna Jaswal
The relationship between heart and the body circulation is analogous to central pumping station of water supply and the distribution system. Whenever multiple blocks develop in the distribution system the central pumping station (heart) is affected. The same concept applies to the heart.The normal size of the heart is equivalent to a closed fist. The normal thickness of the walls of the heart in 6 to 11mm depending on age and gender. When the thickness is more on the left side it is called left ventricular hypertrophy (LVH) and vice versa. Normal weight of the heart ranges from 200 to 400 gramsdepending on the gender and body surface area. When the weight is more it is called increased left ventricle mass.
Whenever the blood pressure remains elevated for more than 6 months, the heart muscles start showing LVH or increased left ventricle mass. This is exactly like the prominent muscles seen in persons performing regular weight lifting. Structural and biological changes in heart resulting from high blood pressure are encompassed by the term hypertensive heart diseasea.
Untreated high blood pressure can cause LVH, increase in LV mass, heart failure, cardiac rhythm disturbances, ischemic heart (coronary) disease and sudden death.
LVH or high left ventricle mass is a result of increase in the work burden of heart muscle cells. The cell becomes larger. Increased thickness results in impaired relaxation of heart muscle. Heart muscles becomes stiff. As a result the physiological low blood pressures inside the heart chambers become high. One gets difficulty in climbing up or walking fast. This may lead to a type of heart failure called heart failure with preserved systolic function. The pumping is fine, only the filling is abnormal.
Gradually, the pumping function also becomes abnormal and we call it heart failure with reduced systolic function. Heart failure risk is 10 times in hypertension with LVH.
Some individuals develop extra beats which are felt as a thump or missing beats. Sometimes the upper chamber (atrium) enlarges which result in irregular heart rhythm (atrial fibrillation). This can cause formation and dislodgement of blood clot from the upper chamber of heart and blockage in blood supply of any part of brain. This results in stroke.
Coronary artery disease (CAD) develops in patients with hypertension at a frequency which is 2 times more than the general population. Silent heart attack, larger size of heart damage and higher complications are seen in hypertension with CAD.
Hypertension causes accelerated rate of arterial blockage. The flow of blood is also abnormal.
Hypertension increases the risk of sudden death by 2.5 times. This is mainly due to higher incidence of Coronary artery disease (acute heart attack) which results in fatal arrhythmia.
The good part is, it is a preventable illness. Both non drug therapy and drug therapy in consultation with a physician helps control blood pressure. One must understand that this is not a curable illness. One can control blood pressure with non-drug therapy and drug therapy. BP should be treated to the target range. Good control of blood pressure will prevent or reverse many changes in heart. This will reduce stroke, heart failure hospitalization and death.
Our ultimate aim should be to avoid high blood pressure development (primordial prevention). The tips for this are (1) No extra salt diet, (2) consume 600 gms of fruits and vegetables daily, (3) maintain ideal body weight, (4) moderate intensity exercise daily for 30-35 minutes along with Yoga and meditation (5) sleep 7 hours daily and (6) finally DONT WORRY BE HAPPY.