What is the diagnosis and treatment for hypertensive (high blood pressure) heart disease?

From the Guidelines

Hypertensive heart disease should be managed with a combination of lifestyle modifications and medications, with a target blood pressure of <130/80 mm Hg, and consideration should be given to lowering the BP even further, to <120/80 mm Hg, as recommended by the American Heart Association 1. The treatment of hypertensive heart disease involves a multifaceted approach, including behavioral modification, such as sodium restriction, and a closely monitored exercise program, as well as pharmacological interventions.

• The American Heart Association recommends the use of diuretics, ACE inhibitors (or ARBs), β-blockers, and aldosterone receptor antagonists to improve outcomes for patients with heart failure, which is a common complication of hypertensive heart disease 1.
• Thiazide diuretics should be used for blood pressure control and to reverse volume overload and associated symptoms, while loop diuretics should be used in severe heart failure or in patients with severe renal impairment 1.
• The choice of ACE inhibitors or ARBs, such as candesartan or valsartan, is equivalent in terms of benefit, and either class of agents is effective in lowering blood pressure 1.
• Beta-blockers, such as carvedilol, metoprolol succinate, and bisoprolol, have been shown to improve outcomes in heart failure and are effective in lowering blood pressure 1.
• The addition of hydralazine/isosorbide dinitrate to the regimen of diuretic, ACE inhibitor or ARB, and β-blocker should be considered in black patients with NYHA class III or IV heart failure, and possibly in other patients as well 1.
• Certain medications, such as nondihydropyridine CCBs, clonidine, and moxonidine, should be avoided in patients with heart failure and hypertension due to their potential to worsen outcomes 1.

From the FDA Drug Label

1. 1 Hypertension Losartan is indicated for the treatment of hypertension in adults and pediatric patients 6 years of age and older, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and nonfatal cardiovascular (CV) events, primarily strokes and myocardial infarction
2. 2 Hypertensive Patients with Left Ventricular Hypertrophy Losartan is indicated to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy

Losartan is used to treat hypertension and reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy.

• The drug label does not explicitly mention hypertensive heart disease.
• However, hypertensive heart disease is a condition where high blood pressure leads to heart problems, and losartan is used to lower blood pressure and reduce the risk of cardiovascular events.
• Based on the available information, losartan may be beneficial in managing hypertensive heart disease by controlling blood pressure and reducing the risk of cardiovascular events, but this is not directly stated in the drug label 2.

From the Research

Hypertensive Heart Disease

• Hypertensive heart disease (HHD) is a result of long-standing hypertension, characterized by changes in the myocardial structure and function in the absence of other primary cardiovascular abnormalities 3.
• The initiating stimulus for HHD is increased blood pressure, with neurohormonal factors, particularly the renin-angiotensin system, playing a key role in remodeling of cardiac chamber geometry and walls 3.

Prevention and Treatment

• Optimal antihypertensive therapy in the setting of therapeutic lifestyle changes is crucial in the prevention and control of HHD 3.
• First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption 4.
• First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker, which should be titrated according to office and home SBP/DBP levels to achieve a target blood pressure of <130/80 mm Hg 4.
• Regression of left ventricular hypertrophy (LVH) is achievable and associated with improved prognosis, with renin-angiotensin system blocking agents being the most effective approach for LVH regression and reverse remodeling in these patients 3.

Lifestyle Interventions

• Applying lifestyle intervention in the form of a continuous care model may be recommended to reduce dietary sodium intake and mean systolic and diastolic blood pressure in patients with hypertension 5.
• Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and is a critical component of first-line treatment for elevated blood pressure or cholesterol 6.
• Physical activity assessment and prescription are an excellent lifestyle behavior treatment option for all patients, including those with mild-moderate-risk patients with elevated blood pressure and blood cholesterol 6.

Management of Stage 1 Hypertension

• For patients with stage 1 hypertension and a low 10-year risk for cardiovascular disease, lifestyle-only approaches are the first line of therapy, with a focus on therapeutic lifestyle changes and physical activity 7.
• The goal of therapy is to achieve a blood pressure target of <130/80 mm Hg, with consideration of antihypertensive medication if lifestyle therapy is not effective after 6 months 7.