Other Conditions

Angina pectoris, or simply angina, is chest pain caused by reduced blood flow and oxygen supply to the heart muscle. It is a symptom of coronary artery disease, or CAD, which happens when the arteries leading to the heart become hardened or narrowed. High blood pressure damages arteries and speeds up the hardening process.

Hypertension also contributes to the development of angina by enlarging the muscular wall of the left ventricle. An increased number of muscle cells that are larger than normal leads to an increased requirement for oxygen. The thickened wall of the left ventricle may compress the very arteries that are bringing oxygenated blood to it. The end result is a decreased ability to provide oxygenated blood to tissue that has an increased oxygen demand.

When the pressure in the circulatory system is higher than it should be, the heart has to work harder. Since the heart is composed of muscle, this extra work causes the heart muscle to get bigger, just like lifting weights makes arm and leg muscles get bigger. However, what’s good for arms and legs may not be good for the heart.

Although both the right and left ventricles of the heart pump blood, the left ventricle has the bigger job. The right ventricle of the heart pumps blood to the lungs, which is a relatively low-pressure system. The left ventricle, however, has to pump blood to the rest of the body. This pumping action naturally requires a higher pressure. In people with hypertension, the left ventricle has to pump against an even higher pressure.

Over a period of time, the left ventricle becomes thicker and more muscular as a result of the extra work. This increased thickness of the ventricular wall is due to an increased number of heart muscle cells, an increase in the size of the cells, and an increase in the fibrous material that holds them together. This condition is called left ventricular hypertrophy, or LVH, and can sometimes be seen on an electrocardiogram or during an echocardiogram.

LVH develops initially as a protective response, designed to make sure that the heart pumps out enough blood to all the organs of the body despite the higher baseline pressure in the circulatory system it must overcome. Eventually, however, the increased thickness of the heart’s walls interferes with proper function. A ventricular wall that is thick and muscular is stiff and doesn’t expand easily. This causes a reduced volume in the chamber and smaller amounts of blood pumped out to the body. If high blood pressure continues to go untreated, this condition may lead to heart failure.

Heart failure, or congestive heart failure, means that your heart can’t pump enough blood to meet the body’s needs. Your heart contracts to push blood out to the rest of the body and relaxes to fill with blood returning to the heart. Heart failure means one or both of these functions isn’t working. In either case the blood simply backs up and causes problems, most notably in the lungs.

As the volume and pressure of blood in the lungs increases, fluid in the blood is forced to move from the blood vessels into the air spaces of the lung itself. This is known as pulmonary edema, and makes breathing difficult.

The extra volume of blood in the lungs also means that the right ventricle has to pump against an increased pressure. When the pressure is high enough that it can no longer do this, blood backs up into the rest of the body. The most susceptible points in the body are those farthest away from the heart, such as the feet, where fluid is forced out of the blood stream and into the tissues. This causes the feet and ankles to swell.

Over time, high blood pressure can lead to problems with vision. Early changes include thickening of the small arteries in the back part of the eye where vision actually takes place. This area is called the retina, and it’s a busy place with many arteries and veins that provide oxygen and nourishment to the vision center.

As the arteries thicken, they begin to collapse the thin walls of nearby veins. Over a long period of time, this pinching can become so severe that the veins have difficulty draining blood away from the retina. This backup eventually leads to increased pressure within the arteries themselves and blocks the entry of fresh blood. When this happens, portions of the retina can be permanently injured, leading to some loss of vision.

One other problem that can occur, with extremely high spikes in blood pressure, is that small vessels within the retina can leak fluid or even bleed. This can cause swelling in the retina that interrupts blood flow to the area. Your provider may be able to detect this problem with a comprehensive eye exam.

Most of these changes can occur without any obvious physical symptoms to warn you. The key to reducing the risk of developing these problems is good control of your blood pressure and a comprehensive eye exam to detect any early signs of problems.