Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hypertens. May 23, 2015; 5(2): 41-52
Published online May 23, 2015. doi: 10.5494/wjh.v5.i2.41
Hypertensive cardiomyopathy: A clinical approach and literature review
Kishio Kuroda, Tomoko S Kato, Atsushi Amano
Kishio Kuroda, Tomoko S Kato, Atsushi Amano, Department of Cardiovascular Surgery, Juntendo University, Bunkyo-ku, Tokyo 113-8431, Japan
Author contributions: Kuroda K and Kato TS contributed same amount to this work; all authors contributed to this work.
Conflict-of-interest: None of the authors has a financial relationship with a commercial entity that has an interest in the contents of the presented manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tomoko S Kato, MD, PhD, FAHA, Department of Cardiovascular Surgery, Juntendo University, Heart Center, Building 9, 1F-Room124A, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan. rinnko@sannet.ne.jp
Telephone: +81-3-38133111 Fax: +81-3-38155228
Received: January 6, 2015
Peer-review started: January 7, 2015
First decision: March 6, 2015
Revised: March 23, 2015
Accepted: April 28, 2015
Article in press: May 2, 2015
Published online: May 23, 2015
Processing time: 134 Days and 22.4 Hours
Abstract

Hypertensive cardiomyopathy (HTN-CM) is a structural cardiac disorder generally accompanied by concentric left ventricular hypertrophy (LVH) associated with diastolic or systolic dysfunction in patients with persistent systemic hypertension. It occurs in the absence of other cardiac diseases capable of causing myocardial hypertrophy or cardiac dysfunction. Persistent systemic hypertension leads to structural and functional myocardial abnormalities resulting in myocardial ischemia, fibrosis, and hypertrophy. HTN-CM is predominantly a disease of impaired relaxation rather than impaired contractility, so patients are usually asymptomatic during resting conditions. However, their stiff left ventricles become incapable of handling increased blood volume and cannot produce appropriate cardiac output with the slight change of circulating volume that may occur during exercise. Importantly, the accompanying LVH is itself a risk factor for mortality and morbidity. Therefore, early detection of LVH development in patients with hypertension (referred to as HTN-CM) is critical for optimal treatment. In addition to pathological findings, echocardiography and cardiac magnetic resonance imaging are ideal tools for the diagnosis of HTN-CM. Timely diagnosis of this condition and utilization of appropriate treatment are required to improve morbidity and mortality in hypertensive patients. This review article presents an overview of the multidimensional impact of myocardial disorder in patients with hypertension. Relevant literature is highlighted and the effects of hypertension on cardiac hypertrophy and heart failure development are discussed, including possible therapeutic options.

Keywords: Hypertension; Diagnosis; Cardiomyopathy; Hypertrophy; Risk assessment

Core tip: Hypertensive cardiomyopathy is a structural cardiac disorder generally accompanied by left ventricular hypertrophy associated with diastolic and/or systolic dysfunction in patients with persistent systemic hypertension, in the absence of other cardiac diseases. Because regression of myocardial hypertrophy is associated with a reduction in cardiovascular risk along with the improvement of cardiac function, timely diagnosis of the disease-specific pathophysiology and appropriate treatment strategy including maintaining optimal blood pressure control is very important in the care of patients with hypertension. In the present review manuscript, we have described the outline of hypertensive cardiomyopathy, pathophysiological feature of the disease, diagnosis and the treatment.