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Sustained hypertension causes structural and functional abnormalities of the heart, involving ventricular and atrial myocardium as well as epicardial and intramural coronary arteries. As a result, three different, although obviously related to each other, cardiac diseases in hypertensive patients may be recognized: heart failure, myocardial ischaemia, and atrial fibrillation9-17. These three main cardiac complications of hypertension can take place separately or combined, at different degrees of severity, or in various evolutive stages18. Díez J, Querejeta R, López B, González A, Larman M, Martínez Ubago J. Losartan-Dependent Regression of Myocardial Fibrosis Is Associated With Reduction of Left Ventricular Chamber Stiffness in Hypertensive Patients. Circulation. 2002;105(21):2512-7. doi:10.1161/01.cir.0000017264.66561.3d - Pubmed

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The first definition of HHD was proposed in 1979 by the New York Heart Association. Hypertensive heart disease was defined as an anatomofunctional alteration characterized by left ventricular hypertrophy (LVH) and cardiac failure in patients with systemic hypertension19. With this definition, HHD was made equivalent to heart failure. The main cause of hypertensive heart disease is elevated peripheral vascular resistance and arterial hypertension. Radiographic features Mavrogeni S, Katsi V, Vartela V et al. The Emerging Role of Cardiovascular Magnetic Resonance in the Evaluation of Hypertensive Heart Disease. BMC Cardiovasc Disord. 2017;17(1):132. doi:10.1186/s12872-017-0556-8 - Pubmed

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Over 1.1 billion people worldwide, one-fourth of all men and one-fifth of all women suffer from hypertension and the condition is in control in less than 20% of the affected population. It is also the main risk factor and cause of hypertensive heart disease 1. Associations

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Iriarte MM, Murga N, Sagastagoitia JD, Morillas M, Boveda J, Molinero E, et al. Classification of hypertensive cardiomyopathy. Eur Heart J 1993;14(Suppl J):95-101.Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23. The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. Boston: Little, Brown, and Co,1979:12. Possible symptoms include dyspnea, angina, syncope, heart failure or even sudden cardiac death. However, in the initial stages, most patients will be asymptomatic 3.

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Eloot S, Van Biesen W, Dhondt A, et al. Impact of hemodialysis duration on the removal of uremic retention solutes. Kidney Int. 2008;73:765-770. Despite a number of studies performed over the years, no comprehensive definition and no clinically meaningful classification of hypertensive heart disease (HHD) is available. That is why the Steering Committee of the Hypertension Working Group of the Spanish Society of Cardiology developed a clinical classification of the so called “hypertensive cardiopathy” based on the three main heart components involved in patients with chronic elevated blood pressure8. This classification is briefly reviewed next. 3- The basis for a clinical classification of hypertensive heart disease Pauly RP, Gill JS, Rose CL, et al. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009;24:2915-2919.In terms of left ventricle involvement, the categories selected have been the three main stages of the former concept of "hypertensive heart disease": response of ventricular myocardium begins with left ventricular hypertrophy (recognised either by electrocardiography or echocardiography); afterwards, diastolic dysfunction may appear, sometimes evolving to systolic dysfunction, despite that symptoms of heart failure may be similar.