Arterial hypertension remains the most frequent cardiovascular (CV) risk factor and it is responsible for a huge global burden of disease: the global prevalence of hypertension was around 1.4 billion in 2010 and it is likely to increase to 1.6 billion by 2025.
Suboptimal BP control is common — over the 75% of treated patients. Initiation or intensification of antihypertensive therapy may prevent cardiac events. However, tissue characterization obtained by cardiac magnetic resonance or computed tomography might significantly help in the distinction of different heart modifications as well as being sensitive to subclinical disease: initiation or intensification of antihypertensive therapy in response to these findings may prevent CV events.
Diffuse interstitial heart fibrosis is the main histological feature associated with hypertension. Today we can visualize and quantify this problems with advanced imaging techniques, especially cardiac magnetic resonance and computed tomography.
These changes evolve over time, and their relationship with blood pressure is confounded by frequently co-existing diseases, including obesity and diabetes. The early recognition of myocardial fibrosis may allow therapeutic responses to prevent the development of heart failure.
The transition to clinical heart failure is influenced not only by BP control but also by a variety of exogenous influences, including obesity and sleeping disorders – primarily obstructive sleep apnoea.
Hypertensive heart disease is significantly associated with coronary artery disease, stroke, and all-cause mortality. A recent trial showed a significant reduction in cardiovascular morbidity and mortality, proportional to the level of BP reduction. A subsequent study confirmed these findings in older patients with hypertension (60–80 years).On these grounds, aggressive antihypertensive therapy is warranted in many cases.
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