Coronary Heart Disease And Hypertension: Connection

Introduction

An increase in blood pressure beyond a normal level is called Hypertension. In hypertension, the heart needs to work harder to circulate blood and which can result in the thickening or hardening of the blood vessels which can lead to a decrease in blood flow to the heart muscles and may cause coronary heart disease.

Coronary arteries are the main supplier of oxygen-rich blood to the heart and if these arteries become thick or hard then there would be difficulty in heart pumping system. Hypertension is the primary cause of coronary heart disease that's why it is important to control hypertension by lifestyle modifications, diet and taking proper medications.

Pathophysiology

Mechanism of coronary heart disease

• In coronary heart disease, coronary arteries which are the primary supplier of blood to the heart muscles become narrowed or thickened or blocked due to the accumulation of fatty deposits called plaque and the process is known as Atherosclerosis
• Hypertension is one of the reasons for plaque formation, cholesterol deposition to the atrial walls, which causes narrowing and thickening of the arterial walls and making difficult for pumping action of heart
• Because of the narrowed and thickened artery, the heart gets less blood supply and causes chest pain, resulting in breathing difficulty especially when a person is active because of the deprived oxygen supply of the heart muscles
• Sometimes, plaque can rupture and clot formation takes place at the site of rupture. Blood clot completely blocked the artery which causes a stopping of blood supply to the heart and results in Heart attack

Mechanism of hypertension 

• Blood pressure is expressed in terms of systolic which is higher reading and diastolic which is lower reading
• When heart is contracted then it is systolic blood pressure and when is heart is relaxed then it is diastolic blood pressure
• Hypertension can be diagnosed when either systolic, diastolic pressure or both are raised
• Hypertension is typically without any symptoms and generally, symptoms can occur only when blood pressure reaches higher levels, usually above 200 mmHg systolic pressure
• Hypertension is usually diagnosed when a person’s blood pressure is repeatedly found to be 140/90 mmHg or higher
• Hypertension leads to narrowing and hardening of arteries causing limited blood supply to the heart and if hypertension is left untreated then it is the major cause of coronary heart disease

How hypertension contributes to coronary heart disease

• Hypertension causes damage to the inner lining of the arteries which can lead to the formation of plaque, cholesterol deposition which can lead to lower blood supply and oxygen supply to the heart resulting in coronary heart disease
• Due to increased blood pressure, it makes it difficult to perform pumping action to the heart and results in heart-related problems
• Hypertension speeds up the process of atherosclerosis which is the hardening and narrowing of the arteries which is the major risk factor in coronary heart disease
• Elevated blood pressure continuously exerts strain on the heart and this can lead to Heart failure and if left untreated for a long time. Weakened pumping action of the heart can contribute to coronary heart disease
• Blood clots can be formed at the site of plaque rupture which completely blocks coronary arteries and stops blood supply to the heart and may result in a heart attack
• It is important to treat hypertension promptly, as this can prevent the further progression of coronary heart disease

Complications of unmanaged hypertension and coronary heart disease

• If hypertension is left untreated then it increases the risk of heart attack, heart failure, kidney damage and other cardiovascular conditions which could be life-threatening
• If these both conditions can not treated on time then it will result in cardiovascular decline
• Hypertension can damage blood vessels in the brain and can cause clot formation or risk of rupture resulting in paralysis, speech impairment, memory loss and it could be life-threatening
• It can cause peripheral artery disease which can restrict blood flow towards the periphery especially towards the legs increasing the risk of infections
• Severe heart damage from coronary heart disease or uncontrolled hypertension can cause the heart to stop beating suddenly and in this case, immediate treatment is needed otherwise it may result in death
• It can damage the blood vessels in the eyes leading in vision problems like blurred vision, bleeding in the eyes, in severe cases blindness or vision loss

Clinical manifestations

Symptoms of hypertension

• Most people with hypertension have no symptoms and very few people with hypertension may have symptoms
• Severe and frequent headaches are common in high blood pressure
• Difficulty in breathing or shortness of the breath during physical exertion or in severe cases even at rest
• Dizziness or fainting
• Nosebleeds in severe cases
• A feeling of pressure or tightness in the chest or chest pain same as indigestion can be a symptom of hypertension
• Extreme tiredness or weakness even without any exertion
• Rapid or irregular heartbeats and extreme sweating especially cold sweats can be symptoms of high blood pressure
• Sometimes, a person may feel nauseated and urge to vomit

Symptoms of coronary heart disease

• Chest pain (Angina) or pressure, or tightness in the chest is the common symptom and it can triggered by physical activity and stress. Pain can radiate to the shoulders, arms, neck or back or jaw
• Feeling tired, weakness usually even after minimal physical exertion
• Shortness of breath or trouble in breathing following any physical activity
• Rapid or irregular heartbeats
• Dizziness or feeling of fainting
• Nausea and vomiting
• Some people may experience indigestion-like symptoms
• Excessive sweating without any physical exertion especially cold sweats
• Swelling in the feet, ankles or legs can be seen in the later stages of poor heart conditioning

Prevention and management

• Lifestyle modifications, focus on healthy balanced diet, limited intake of fatty, oily foods, increase protein intake
• Avoid refined sugar, processed food and reduce salt intake
• Regular exercise like walking, cycling and exercise which improve cardiovascular activity
• Maintain a healthy weight
• Limited alcohol intake, quit smoking and tobacco
• Practice stress-reducing techniques such as meditation, yoga and maintain good sleep hygiene
• Regular monitoring of blood pressure and blood tests for checking cholesterol levels
• Controlling diabetes, high cholesterol and other risk factors to prevent further heart disease progression
• Seek medical professional help for medications like antihypertensive drugs, blood thinners, beta-blockers for the management of symptoms
• Some people might need surgical intervention like angioplasty, stent placement, or bypass surgery for the management of symptoms
• People can get help from rehabilitation programs which focus on exercise, diet and stress management

FAQs

Can lowering blood pressure reduce the risk of coronary heart disease?

Yes, controlling blood pressure through lifestyle modifications and medications can reduce the risk of coronary heat disease and it can prevent further damage to the arteries and other heart related problems.

Can hypertension be reversed, and how does that impact coronary heart disease?

Not always, though it can be controlled through lifestyle modifications and medicines and then it can prevent further progression of other heart-related complications.

Can stress contribute to the development of both hypertension and coronary heart disease?

Yes, stress hormones can constrict blood vessels and increase blood pressure which can contribute to the risk of cardiovascular issues and further complications. 

Can controlling hypertension help prevent coronary heart disease?

Yes, controlling hypertension can significantly lower the risk of developing coronary heart disease. Maintaining a normal blood pressure helps protect the arteries from damage and further heart-related issues. 

How does regular exercise help with hypertension and coronary heart disease?

Regular exercise strengthens the heart, lowers blood pressure, improves blood circulation, helps maintain a healthy weight result in reducing the risk of hypertension and coronary heart disease.

Summary

Hypertension can cause damage to the blood vessels supplying blood supply to the heart and it may lead to plaque formation, narrowing or hardening of the blood vessels and eventually affect pumping action of the heart. It will increase the risk of heart attack, heart failure and other cardia-related problems due to poor blood supply which is why it is important to treat hypertension timely.

Lifestyle modifications, dietary changes, managing stress, weight management, medications and even surgery in severe cases, and regular health checkups for monitoring blood pressure, and cholesterol levels can prevent and manage these conditions.