Hypertensive heart disease can cause problems because of long-term, unmanaged high blood pressure (hypertension). The added strain on your heart from working harder could make your heart muscle thicken. It can also lead to heart failure. This is why it’s important to know if you have high blood pressure and to treat it if you do.
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Hypertensive heart disease is a condition with damage to your heart from years of unmanaged or undermanaged high blood pressure. You may have thick and weak heart muscle (left ventricular hypertrophy or LVH) from strain on your heart. This can lead to heart failure. This happens because long-term high blood pressure (hypertension) makes it harder for your heart to pump blood. And it often makes it more difficult for your heart muscle to relax.
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The walls of your blood vessels can also thicken because of high blood pressure. This becomes more dangerous when cholesterol collects inside the blood vessels. It raises your risk of coronary artery disease, heart attack and stroke.
In the U.S., 1 out of every 3 adults has high blood pressure. But only half of those with the diagnosis manage it well. Hypertensive heart disease is the number one cause of illness and death due to high blood pressure.
High blood pressure often doesn’t have symptoms. This is why symptoms of hypertensive heart disease often show up after you already have damage in your heart.
Hypertensive heart disease symptoms include:
Having high blood pressure for years without managing it causes hypertensive heart disease. Often, the cause is as simple as not taking medicines as prescribed.
Risk factors for hypertensive heart disease include:
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High blood pressure makes it more difficult for your heart to push blood through your blood vessels. In response to this strain, your heart muscle can thicken (LVH), and coronary arteries can change. This can lead to coronary artery disease.
Other complications of hypertensive heart disease include:
About 1 in 4 cases of heart failure comes from this disease. People who have hypertensive heart disease with heart failure have a higher risk for:
Since high blood pressure doesn’t have symptoms, your healthcare provider needs to check for it. They’ll also do a physical exam and look at your personal and family history.
Your provider will want to rule out other problems that cause heart failure, like ischemic cardiomyopathy (heart failure due to disease in your heart’s arteries). Tests include:
An EKG or echo can show hypertensive heart disease without heart failure at an early stage, with or without symptoms. Early on, your lower heart chambers may not relax as they should. This is called diastolic dysfunction.
Then, you may develop LVH. After that, you may show signs of heart failure as your condition worsens. During end-stage hypertensive heart disease, your heart can’t pump as much blood as it used to. A lower ejection fraction score during an echo reflects this problem.
Hypertensive heart disease treatment includes taking medicine for high blood pressure, making changes to your daily life and managing related conditions. If you need more medicine to treat high blood pressure, your provider will prescribe it. They may suggest medicines that relax your blood vessels or slow your heart rate, for example. Reducing your blood pressure can reduce your risk of heart failure. Treatment can reverse hypertrophy in an early stage.
Treatment may include:
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Visit your provider regularly to make sure you’re managing your blood pressure. If your blood pressure readings at home show rising numbers, contact your provider. They may need to prescribe more medicine for you.
You should also contact your provider if you have symptoms of hypertensive heart disease, like chest pain and shortness of breath.
Questions to ask your provider may include:
Hypertensive heart disease is a long-term disease that takes years to develop. Over time, people who have it are at a higher risk of dying from a heart and blood vessel problem. You need regular visits with your healthcare provider.
The prognosis (outlook) for people with this condition is different from person to person, depending on:
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An enlarged left ventricle, heart failure or atrial fibrillation typically leads to a worse prognosis.
There are several things you can do, like:
You can prevent hypertensive heart disease by managing your blood pressure. Get your blood pressure checked once a year if you’re older than 18. Get readings more often if your numbers are high. If your blood pressure is high, bring it down and keep it down. You can purchase a blood pressure monitor that you can use at home.
Any medicine can have side effects, but it’s important to keep taking your blood pressure medicines. If you’re having side effects, your provider may be able to switch you to a different medicine.
When managing your blood pressure, it’s also helpful to:
It can be frustrating to learn that a condition you’ve been dealing with for many years has led to another problem. But your healthcare provider can help you by suggesting treatments to manage hypertensive heart disease. You have the power to make healthy changes in your life for a healthy heart.
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When your heart needs some help, the cardiology experts at Cleveland Clinic are here for you. We diagnose and treat the full spectrum of cardiovascular diseases.
Last reviewed on 12/23/2025.
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