Changing Concept of Hypertensive Heart Disease

Joong-Wha Chung

doi:10.5646/jksh.2012.18.4.137

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Chung: Changing Concept of Hypertensive Heart Disease

Review

Journal of the Korean Society of Hypertension

Journal of the Korean Society of Hypertension 2012; 18(4): 137-145.

Published online: 31 December 2012

DOI: https://doi.org/10.5646/jksh.2012.18.4.137

Changing Concept of Hypertensive Heart Disease

Joong-Wha Chung, MD

Division of Cardiology, Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.

Corresponding author (jwchung@chosun.ac.kr)

Received 6 September 2012 Revised 18 September 2012 Accepted 21 September 2012

Abstract

Arterial hypertension leads to both structural and functional changes of the heart. Hypertensive heart disease (HHD) is characterized by complex changes in myocardial structure (e.g., enhanced cardiomyocyte growth, excessive cardiomyocyte apoptosis, accumulation of interstitial and perivascular collagen fibers, disruption of endomysial and perimysial collagen network) that cause the remodeling of the myocardium. In the 1970s, hypertrophic growth of cardiomyocytes is compensatory to reduce wall stress on the ventricular wall imposed by pressure overload. Recent data from animal studies suggest that inhibition of ventricular hypertrophy was not associated with ventricular dilatation or reduced wall motion despite elevated wall stress. The genetic complexity (gene-gene and/or gene-environment interactions) may modulate left ventricular mass and transcriptional regulators are participated in pathologic myocardial growth. Many hormones and cytokines lead to a profibrotic and inflammatory environment. Excess of ventricular collagen in hypertensive patients is the result of both increased collagen synthesis by fibroblasts and stimulated myofibroblasts, and unchanged or decreased collagen degradation by matrix metalloproteinase. Several biochemical markers of myocardial remodeling will prove to be useful. The development of noninvasive methods like echoreflectivity, cardiac magnetic resonance imaging, speckle tracking echocardiography, and cardiac molecular imaging would enable broader application. Meta-analysis showed that there was a significant difference among medication classes in decreasing left ventricular mass.

Keywords: Heart diseases, Hypertension, Ventricular remodeling, Ventricular hypertroph

Figures and Tables

Table 1

Molecules involved in myocardial remodeling in hypertensive heart disease (From Diez J, et al. Hypertension. 2010; 55:1-8)10)

Table 2

Circulating biomarkers of hypertensive heart disease

PICP, procollagen type I C-terminal propeptide; MMP, matrix

metalloproteinase; TIMP, tissue inhibitors of metalloproteinases.

Table 3

Imaging modalities to assess hypertensive heart disease

2D, 2-dimensional; 3D, 3-dimensional; MRI, magnetic resonance imaging.

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