Hypertensive Cardiovascular Disease

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Sudden death in individuals with hypertension is usually associated with, and probably in most instances due to, accompanying coronary atherosclerosis. The atherosclerosis present can be either the usual form, with eccentric plaque-like deposits of atheromatous material, or a concentric form with uniform thickening of the coronary arteries. In the latter case, while the lumen may be technically patent, the severe concentric narrowing of the vessels accomplishes the same hemodynamic effect as the eccentric plaques, that is, a reduction in blood flow to the myocardium.

In some individuals with a history of hypertension who die suddenly and unexpectedly, the autopsy will reveal only an enlarged heart with marked left ventricular hypertrophy and minimal or absent coronary atherosclerosis.23 The mechanism of death in these cases is a cardiac arrhythmia, most likely ventricular fibrillation. It has been known clinically for some time that patients with left ventricular hypertrophy have significantly more ventricular premature contractions than normal individuals or individuals with hypertension without left ventricular hypertrophy.24-26 This clinical observation is in agreement with the observations of forensic pathologists that a small but significant number of individuals who die suddenly and unexpectedly with a clinical history of hypertension have only left ventricular hypertrophy, without severe atherosclerotic involvement of their coronary arteries or the small vessels of the myocardium. In contrast to individuals with hypertension coming to autopsy in hospitals, most individuals dying suddenly and unexpectedly of a cardiac arrhythmia with a clinical history of hypertension do not show the gross changes of hypertension in their kidneys, that is, the fine granularity of the cortical surfaces, though, microscopically, there is evidence of arteriosclerosis.

In regard to the left ventricular hypertrophy in individuals with hypertension, electrocardiographic studies have shown increases in left ventricular mass in young individuals 12-20 years of age, before arterial pressure reached levels considered abnormal in adults.27 This is in agreement with the observation of the authors that some individuals in their late teens and early twenties in populations that are particularly susceptible to hypertension (e.g., blacks) have shown left ventricular hypertrophy consistent with hypertension without any clinical history of hypertension but with a family history of hypertension.

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Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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