What are the treatments for hypertensive heart disease?

What are the treatments for hypertensive heart disease?

What are the treatments for hypertensive heart disease?

Treatment

1. Control blood pressure early
Early blood pressure compliance is the primary task in the treatment of hypertensive heart disease, and the SBP target value should be considered <140mmHg.

2. The importance of reversing LVH
The Framinghan Heart Study has confirmed a reduction in LVH and a decrease in cardiovascular mortality through long-term follow-up. Reversal of LVH includes non-drug therapy: optimized lifestyle, low-salt diet; weight control; alcohol restriction; reduction of certain sympathetic active hormones, such as elevated catecholamines, renin angiotensin system (RAS) activation stress status. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-converting enzyme receptor antagonist (ARB) may prevent LVH and myocardial fibrosis in antihypertensive drugs. Animal experiments and human studies have also confirmed that calcium antagonists (CCB) can reverse LVH.



3. Heart failure treatment
In the case of heart failure, the mortality rate is high when there are obvious symptoms, so it is necessary to strengthen the prevention and treatment of early asymptomatic heart failure (systolic or diastolic cardiac dysfunction). For systolic heart failure, it is recommended to use ACEI, beta blockers, diuretics, ARB and / or aldosterone inhibitors to reduce mortality and hospitalization rates. For hypertensive patients with diastolic heart failure (heart failure with retained ejection fraction), there is no evidence to suggest that antihypertensive therapy or any antihypertensive drug is beneficial. However, for these patients and patients with hypertension and decreased systolic function, SBP should be considered to be below 140 mmHg.

4. Combined treatment of coronary heart disease
There are many risk factors that can lead to coronary heart disease, but blood pressure levels are one of the important factors. Blood pressure levels are associated with a high risk of coronary heart disease, and the risk of coronary heart disease increases sharply after SBP > 140 mm Hg. For hypertensive patients with coronary heart disease, the target value of blood pressure <140mmHg. For patients with a history of myocardial infarction, beta blockers are recommended. For other patients with coronary heart disease, all blood pressure lowering drugs can be used. In order to relieve the symptoms of angina pectoris, β blockers and calcium antagonists are preferred.

5. Combined treatment of atrial fibrillation
Hypertension is the most common complication of atrial fibrillation and may be a reversible pathogenic factor in atrial fibrillation. For patients with hypertension and atrial fibrillation, the risk of thromboembolism should be adequately assessed. Unless contraindicated, most patients should receive oral anticoagulant therapy to prevent stroke and other embolic events. In patients with hypertension and left ventricular hypertrophy or cardiac insufficiency, the use of AECI or ARB is recommended to prevent the occurrence of atrial fibrillation; there is evidence that beta blockers and aldosterone antagonists may prevent atrial fibrillation.