Hypertension is the number two cause of chronic heart failure.
How does chronic high blood pressure cause heart failure over time?
Chronic high blood pressure can lead to heart failure over time through a series of complex mechanisms. Heart failure occurs when the heart is unable to pump blood effectively to meet the body's needs. Hypertension places increased stress on the heart and blood vessels, leading to structural and functional changes that can result in heart failure (Oh & Cho, p.1, 2020). Hypertension causes an increase in systemic vascular resistance, which is the force that the heart must overcome to eject blood into the circulatory system. This increased afterload makes the heart work harder with each beat, leading to hypertrophy (thickening) of the heart muscle, and over time, this can impair the heart's ability to contract effectively (Oh & Cho, 2020).
The heart's left ventricle (the main pumping chamber) often bears the effect of increased pressure. It responds by becoming thicker, which initially helps to maintain cardiac output. However, this hypertrophy is a maladaptive response and can eventually lead to reduced compliance (stiffness) of the ventricle, impairing its ability to relax.
Chronic hypertension can contribute to the development of atherosclerosis (narrowing and hardening) in the coronary arteries, which supply blood to the heart muscle. Reduced blood flow to the heart can result in ischemia (lack of oxygen), leading to myocardial damage and decreased cardiac function.
The continuous strain on the heart caused by hypertension can lead to the deposition of collagen and fibrous tissue in the heart muscle. This myocardial fibrosis can reduce the heart's contractility and impair its ability to pump blood effectively.
As the left ventricle becomes stiffer due to hypertrophy and fibrosis, it becomes less able to relax during diastole (the phase when the heart fills with blood). This condition, known as diastolic dysfunction, reduces the ventricle's ability to accommodate and pump blood, leading to elevated filling pressures and decreased cardiac output.
Hypertension can also increase the risk of irregular heart rhythms (arrhythmias), which can further impair the heart's pumping function.
High blood pressure can damage the delicate lining of blood vessels (endothelium), promoting inflammation and oxidative stress. This, in turn, can contribute to atherosclerosis and increase the risk of heart disease.
Chronic hypertension activates the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system, which can lead to Na and water retention, increased blood volume, and higher blood pressure. These changes can exacerbate the workload on the heart.
Hypertension can damage the kidneys over time, leading to fluid and Na retention, which can further elevate blood pressure and increase the heart's workload.
As heart failure progresses, the impaired pumping ability of the heart can lead to fluid accumulation in the lungs (pulmonary congestion) and in the peripheral tissues (edema). These symptoms can worsen heart failure symptoms and further reduce cardiac function.
Lifestyle choices significantly impact the development and progression of chronic high blood pressure and its potential consequences, including heart failure (Mills et al., 2020). Consuming a diet high in sodium can lead to fluid retention and increased blood pressure, and over time, this can contribute to the development of hypertension. A sedentary lifestyle is associated with weight gain and obesity, which are risk factors for hypertension. Excess body weight, particularly abdominal obesity, is a significant risk factor for hypertension. Smoking can damage blood vessels and increase the risk of hypertension. Poor sleep quality, particularly in the case of sleep apnea, has been linked to hypertension. High stress levels can lead to the release of stress hormones, which can temporarily increase blood pressure. Therefore, chronic stress may contribute to the development and exacerbation of hypertension (Del Gobbo et al., 2015).
Lifestyle choice modifications:
A diet low in potassium-rich foods, such as fruits and vegetables, may reduce the body's ability to balance sodium levels, potentially exacerbating hypertension.
Regular physical activity helps maintain a healthy weight, improve blood vessel function, and lower blood pressure.
Losing weight through a combination of diet and exercise can help reduce blood pressure.
Consuming excessive amounts of alcohol can raise blood pressure. Limiting alcohol intake or abstaining can help control hypertension.
Quitting smoking is essential for overall cardiovascular health.
Stress management techniques such as meditation, deep breathing exercises, and relaxation can be beneficial.
Treating sleep disorders can help manage blood pressure.
For individuals with hypertension, lifestyle changes alone may not be sufficient to control blood pressure. Adhering to prescribed medications as directed by a healthcare provider is crucial for managing blood pressure effectively.
Overconsumption of caffeine and stimulants found in energy drinks can lead to spikes in blood pressure. Moderation is key for individuals with or at risk of hypertension.
Resistance training causes an acute increase in blood pressure.
Is resistance training safe for individuals with hypertension?
Resistance training can cause an acute increase in blood pressure during and immediately after a workout. This well-documented phenomenon might raise concerns about its safety for individuals with hypertension (Carpio-Rivera et al., 2016). However, I think that resistance training can be safe and even beneficial for individuals with hypertension, but it should be approached with caution and under proper guidance. While resistance training does cause a temporary increase in blood pressure, this elevation is typically brief and returns to baseline levels quickly after the exercise session. This short-term elevation is not necessarily harmful and is different from chronic high blood pressure caused by wrongful lifestyle choices in many cases. Engaging in regular resistance training can lead to many long-term benefits for individuals with hypertension. It may help lower resting blood pressure and reduce the risk of atherosclerosis in individuals with hypertension. Resistance training can lead to favorable changes in arterial stiffness, making the arteries more compliant. This reduces the resistance to blood flow and lowers blood pressure (Carpio-Rivera et al., 2016).
Therefore, in my opinion, resistance training, when done appropriately with the supervision of health and fitness professionals, may prevent more complications.
In summary, chronic high blood pressure can lead to heart failure through a combination of increased afterload, structural changes in the heart, reduced coronary blood flow, and the development of multiple pathological processes. Managing hypertension through lifestyle modifications and medications is crucial to prevent or slow down the progression of heart failure in individuals at risk.
References
Carpio-Rivera, E., Moncada-Jiménez, J., Salazar-Rojas, W., & Solera-Herrera, A. (2016). Acute Effects of Exercise on Blood Pressure: A Meta-Analytic Investigation. Arquivos brasileiros de cardiologia, 106(5), 422–433. https://doi.org/10.5935/abc.20160064
Del Gobbo, L. C., Kalantarian, S., Imamura, F., Lemaitre, R., Siscovick, D. S., Psaty, B. M., & Mozaffarian, D. (2015). Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults: The Cardiovascular Health Study. JACC. Heart failure, 3(7), 520–528. https://doi.org/10.1016/j.jchf.2015.02.009
Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature reviews. Nephrology, 16(4), 223–237. https://doi.org/10.1038/s41581-019-0244-2
Oh, G. C., & Cho, H. J. (2020). Blood pressure and heart failure. Clinical hypertension, 26, 1. https://doi.org/10.1186/s40885-019-0132-x
