Harvard Medical SchoolHarvard Medical SchoolHypertensive Heart DiseaseGene BukhmanJanuary 12th, 2005Harvard Medical SchoolEpidemiology INumber of Patients with Hypertension in the Unite !tates" 50 mi##ionNumber of Patients with Heart $ai#ure" 5 mi##ionPer%ent of Heart $ai#ure Patients with Hypertension" &5'JNC 7. 2004Jessup and Brozena. NEJ. 200!Harvard Medical Schoolosterd et al. NEJ. "##7Harvard Medical Schoolortality in Hypertension50' from is%hemi% heart isease or heart fai#ure((' from %erebro)as%u#ar isease10 to 15' from rena# fai#ure$aplan in %ipes& 'i((y& Bono)& and Braun)ald. 200*Harvard Medical SchoolHypertensive Heart Disease*oronary +rtery ,iseaseHeart $ai#ure- ,iasto#i% ,ysfun%tion .mpaire re#a/ation 0eft )entri%u#ar myo%yte hypertrophy .nterstitia# fibrosis- !ysto#i% ,ysfun%tion .s%hemi% %ariomyopathy 0ate %onse1uen%e of after#oa+rrhythmias- +tria# fibri##ation 0eft atria# en#ar2ement- 3entri%u#ar +rrythmias$aplan in %ipes& 'i((y& Bono)& and Braun)ald. 200*Harvard Medical School'e+t ,entri-ular Hypertrop.y I*on%entri% in%rease in 03 mass*ompensatory response to in%rease after#oa*o##a2en4yo%yte hypertrophy'orell and Cara(ello. Cir-ulation. 2000Harvard Medical School'e+t ,entri-ular Hypertrop.y II5ffe%t of me%hani%a# #oain2 most %#ear in rapi re2ression fo##owin2 aorti% )a#)e rep#a%ement.n systemi% hypertension %onfoune by ro#e of an2iotensin .. an sympatheti% hormones03H often e)e#ops after other si2ns of iasto#i% ysfun%tion in H6N03H a#so seen to pre%ee e)e#opment of systemi% H6N'orell and Cara(ello. Cir-ulation. 2000Harvard Medical SchoolJessup and Brozena. NEJ. 200!Harvard Medical SchoolConse/uen-es o+ ',H +#thou2h initia##y %ompensatory, 03H u#timate#y asso%iate with risk of %ario)as%u#ar e)ents simi#ar to history of prior myo%aria# infar%tion .s%hemia- ,e%rease %oronary reser)e with in%rease 03 mass an2ina- Greater risk of eath fo##owin2 myo%aria# infar%tion Heart $ai#ure- ,epresse 03 systo#i% an iasto#i% fun%tion +rrhythmia- +tria# fibri##ation- 3entri%u#ar arrhythmias Nonuniform a%tion potentia# pro#on2ation +#tere repo#ari7ation !pe%ifi% )u#nerabi#ity to torsaes .s%hemi% )entri%u#ar arrhythmiaDunn and 0+e++er. NEJ. "###Harvard Medical SchoolE-.o-ardiograp.y 1indings in 2ystemi- H3N0eft atria# en#ar2ement4itra# annu#ar %a#%ifi%ation- 4i# to moerate mitra# re2ur2itation+orti% root i#atation+orti% )a#)e s%#erosis- 4i# aorti% re2ur2itation,iasto#i% ysfun%tion-.mpaire re#a/ation-8estri%ti)e pattern8eu%e e9e%tion fra%tion- Usua##y #ate %onse1uen%e with )entri%u#ar i#atation!ymmetri% #eft )entri%u#ar hypertrophy4tto. 2000Harvard Medical School5urigemma and 6aas-.. NEJ. 2004Harvard Medical SchoolDiastoli- Dys+un-tion5urigemma and 6aas-.. NEJ. 20047ed+ield. NEJ. 2004Harvard Medical School0ossi(le 7oleo+ ',H determinationin systemi- H3N1: !e#e%tion of patients for treatment2: *hoi%e of treatment a2ent(: 4onitorin2Harvard Medical SchoolE-.o-ardiograp.i-evaluation o+ ',H$ramin2ham as e%ho%ario2raphy in 1;&;5*G probab#y has 10 years o#Present in 20 to (0 per%ent of otherwise #ow risk patients with H6N'orell and Cara(ello. Cir-ulation. 2000Harvard Medical Schoolultiple met.ods o+ e-.o-ardiograp.i- le+t ventri-ular mass -al-ulation034 ? 0:= / @1:0> / A03., B 03PC6 B .3!6D( -03.,(E0imits set by 2 stanar e)iations of the $ramin2ham %ohort meanPoor reprou%ibi#ityPossib#e a)anta2e of %aria% 48 A4annin2 200>D'orell and Cara(ello. Cir-ulation. 2000Harvard Medical School3reatment o+ Hypertension and 5(solute Cardiovas-ular 7is8Benefit of treatment proportiona# to o)era## %ario)as%u#ar risk8isk in%reases with #e)e# of b#oo pressure without %#ear thresho#a-a.on. NEJ. 2000Harvard Medical School',H and treatment o+ H3N8e2ression of 03H with treatment by a## %#asses of a2ents e/%ept ire%t )asoi#atorsPossib#e superiority of a%e inhibitors an an2iotensin re%eptor b#o%kersNot %#ear if benefit to 03H re2ression inepenent from o)era## benefit of b#oo pressure reu%tionHarvard Medical School'osartan Intervention +or endpoint redu-tion 9'I1E: trialDa.lo+ et al. 'an-et. 2002Harvard Medical School5CC;5H5;52E 200! 6uidelinesdire-ted e-.o-ardiogram may (e indi-ated +or t.is purpose.C.eitlin et al. 5CC;5H5;52E. 200!Harvard Medical School5CC;5H5;52E 200! 6uidelines