Definition
• Elevated blood pressure resulting in an increase in left ventricular mass and concentric wall thickening of the left ventricle
Pathogenesis
• An early response to hypertension
• Hypertension causes a chronic increase in afterload, which leads to an increase in the size and number of sarcomeres in the myocardial cells and causes left ventricular hypertrophy
• Hypertension also causes interstitial fibrosis, which leads to left ventricular stiffness and an increase in end-diastolic pressure
• The degree of left ventricular hypertrophy can vary unrelated to the severity of hypertension, which suggests an undetermined genetic component
Clinical features
Epidemiology
• One of the major causes of diastolic heart failure
• In hypertensive patients with left ventricular hypertrophy there is associated ventricular arrhythmias, decreased left ventricular ejection fraction, and myocardial infarction
Presentation
• Diagnosed by echocardiogram
• Symptomatic diastolic heart failure can be seen as dyspnea and fatigue
Prognosis and treatment
• Antihypertensive therapy including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, beta blockers, and diuretics
• ACE inhibitors, ARBs, and calcium channel blockers cause regression of left ventricular hypertrophy more than beta blockers
Pathology
Gross
• Enlarged left ventricle
• Concentric thickening of the left ventricular wall
Histology
• Myocyte hypertrophy often with increased lipofuscin
• Increasing interstitial fibrosis with severity and duration
Immunopathology/special stains
• Not contributory
Main differential diagnoses
• Hypertrophic cardiomyopathy: often asymmetric hypertrophy, myocyte disarray, and more fibrosis
• Dilated cardiomyopathy: enlarged chambers
Fig 1 Hypertensive heart disease. Gross photograph of cross-section of heart with concentric left ventricular hypertrophy in hypertensive heart disease.
Fig 2 Hypertensive heart disease. Medium-power (A) and high-power (B) views of myocyte hypertrophy with mild fibrosis in hypertensive heart disease. Note the variably enlarged nuclei of the myocytes and increased lipofuscin.