What High Blood Pressure Does To Your Heart

Dealing with high blood pressure can be a challenge, and given it may have no obvious symptoms, it can be hard to comply with medication and lifestyle regimens.

However, it is vital to get your blood pressure down to help prevent the damage that it can do to your heart. High blood pressure is strongly linked to an increased risk of heart disease and heart attack. Heart disease is the number one cause of death, so anything you can do to reduce your risk is beneficial.

Controlling blood pressure mitigates this risk and can extend your life.

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How high blood pressure affects your heart

It is harder for your blood to flow through your body when you have high blood pressure, and this means your heart has to work extra hard to do its job. The blood flow to your heart can be reduced as a result. Basically, your heart is having to do more with less, which can lead to the following serious problems:

Heart failure

Heart failure means that your heart can no longer provide enough blood and oxygen to your organs, and your heart can become weakened over time. High blood pressure causes heart failure  through a two-step mechanism:

  1. Hardened and narrowed arteries mean that your heart, again, has to work a lot harder. Your heart is a muscle, and making it work too hard can put it under strain, just as lifting heavy weights strains your muscles.

  2. Because your heart has to work harder, like any other muscle, it bulks up and becomes larger. However, because your heart is a different type of muscle, this makes it less efficient, and then it needs to work even harder.

Heart failure is a chronic disease that has to be managed for life. Symptoms may include:

  • Shortness of breath with activity

  • Shortness of breath when lying down

  • Reduced ability to exercise

  • Persistent cough or wheezing, often with a white or pink mucus

  • Fatigue

  • Weakness

  • Swollen legs, ankles, or feet

  • Rapid or irregular heartbeat

  • Swelling in the abdomen

  • Rapid and sudden weight gain

  • Nausea

  • Lack of appetite

  • Decreased alertness

Heart failure can affect any and every part of your body. Symptoms are caused by insufficient blood flow and/or oxygen to parts of your body.

The treatment for heart failure overlaps with the treatment for high blood pressure. You may have your medications changed to those which treat both conditions, such as ACE inhibitors. Diuretics, also known as water pills that help you excrete extra fluid through urination, are a first-line choice for high blood pressure and also help with heart failure. Your doctor will also recommend lifestyle changes, such as limiting salt and alcohol consumption and being more active.

Your doctor might add additional medications to your regime to achieve the best possible result. If your heart failure becomes more severe, you might have an implantable cardioverter-defibrillator, protecting you from dangerous heart rhythms.

Rarely, people with severe heart failure may need a heart transplant, although in many cases, you can manage heart failure with medications.

There is no cure for heart failure, but medications and lifestyle changes can control symptoms and improve quality of life. If you have been diagnosed with heart failure, it is important to keep taking any prescribed medication and follow your doctor's instructions.


Angina is chest pain caused by reduced blood flow to the heart. It is typically a symptom of coronary artery disease, which can be caused or aggravated by high blood pressure. Angina generally increases with physical activity, emotional stress, heavy meals, or low temperatures.

Be aware that in cisgender women, angina can manifest with different, more vague symptoms, including nausea, shortness of breath, abdominal pain, discomfort in the neck, jaw, or back. Because of this, women with angina may be misdiagnosed.

Not enough studies have been done on anginal symptoms in trans men or women on hormone therapy. Both trans men and trans women should be aware that they might present with more typical male or more typical female symptoms, depending on individual differences and how long they have been on hormone therapy, as well as whether they have had gender-affirming surgery.

Angina is treated with various medications, with the most common being nitrates, which relax and widen your blood vessels. Nitrates are often taken as needed, that is to say, either when you have chest pain or before doing something you expect to cause chest pain, such as exercise.

Beta-blockers and calcium channel blockers are good medication choices for both high blood pressure and angina and are likely to be prescribed to people who have both conditions. You are also likely to be prescribed statins, which lower blood cholesterol and can help prevent coronary artery disease from getting worse.

Some people with angina and significant heart blockage might need surgery, typically an angioplasty with a stent or coronary artery bypass surgery. The latter is generally a last resort if your angina is not responding to other treatments. It is a complicated process that involves removing an artery or vein from another part of your body and grafting it so that it bypasses the blocked artery and helps restore adequate blood flow to the heart.

If you have angina, you should talk to your doctor about safe exercise, eating a healthy diet, avoiding overeating, lowering your stress levels, and limiting alcohol intake. You should also quit smoking, which is the single best thing you can do for your overall health.

A routine exercise regimen and eating a healthy diet can also prevent angina from developing in the first place, whether or not you have high blood pressure.

Angina can sometimes be mistaken for other causes of chest pain, including acid reflux, also known as GERD. Pain that increases with exertion is, however, reasonably standard for angina. While it is not definitive, it is a sign you should talk to your doctor about diagnostic testing for coronary artery disease.

Enlarged left heart

Left ventricular hypertrophy (LVH)  is an enlargement of the left side of your heart. The left side of your heart does most of the work and is more likely to "bulk up" when forced to push blood through narrowed arteries. When this happens, the heart can pump less efficiently and sometimes weaken.

There appears to be a genetic component that determines who develops this problem and who doesn't. It is often found in patients who have had undetected hypertension for a while, making it a particularly good reason to get yourself tested regularly. LVH is often asymptomatic until heart failure starts to develop.

Patients with LVH are at an increased risk of heart attacks, but treatment can help manage the condition. This means controlling your blood pressure and using specific blood pressure medication known to help with an enlarged heart. In addition to ACE inhibitors and angiotensin II receptor blockers, doctors will typically consider long-acting calcium channel blockers and/or thiazide diuretics.

Proper treatment can help prevent further heart damage and reduce your risk of heart failure or a heart attack.

Hypertension and heart attack risk

All of the above conditions increase your risk of a heart attack, which is more technically called a myocardial infarction. A heart attack happens when part of your heart isn't getting enough blood and loses function.

Heart attack symptoms include:

  • Pain or discomfort at the center or left side of the chest which is persistent or goes away and comes back

  • Weakness

  • Light-headedness

  • Cold sweating

  • Pain or discomfort in the jaw, neck, or back.

  • Pain or discomfort in the arms or shoulders, usually the left side

  • Shortness of breath

As with angina, women are more likely to have less typical symptoms, including unusual or unexplained tiredness and nausea, although they can sometimes have general symptoms.

It's vital that if you have hypertension, especially if you do have signs of coronary artery disease or heart failure, you and those around you are aware of the symptoms of a heart attack, including the ones experienced by women. If you think you or somebody else is having a heart attack, call 911 immediately.

Chest pain can also be caused by heartburn, lung problems, muscle spasms in your esophagus, and other non-heart conditions. Even stress or anxiety can cause chest pain. However, if you are in any doubt about the cause of your chest pain, it's best to call 911 or go to the emergency room (ER). The ER can also help with other causes of chest pain and may refer you to a gastroenterologist or pulmonologist for further testing.

Chest pain should always be taken seriously if you have high blood pressure. Unless you are prone to heartburn and recognize other symptoms such as an acid-like taste in your mouth, it's best not to take any risks and seek medical evaluation.

The higher your blood pressure, the higher your risk of heart problems. Managing your weight can also help keep you from experiencing a heart attack. People who have already had one heart attack are at greater risk of another, and a second heart attack soon after a first is particularly dangerous¹. Most people now survive their first heart attack, but of those readmitted with a second heart attack within 90 days of the first, nearly 50% will die within five years.

How to keep your high blood pressure from damaging your heart

The higher your blood pressure, the higher the risk to your heart, and the more damage done to your heart. Therefore, the best way to protect your heart is simply to follow your doctor's guidelines to keep your blood pressure down.

It's also a good idea to assume your heart is at risk and follow normal guidelines for heart-healthy living. Thankfully, these tend to be very similar to the lifestyle changes recommended for controlling high blood pressure. Lowering sodium intake, for example, is good for your heart.

Your doctor will monitor your heart carefully and may recommend regular echocardiograms or ECGs to help detect and monitor the progress of coronary artery disease and to check your heart for enlargement. You may need additional medication to help keep your heart healthy.

Can the damage done by high blood pressure be reversed?

In most cases, the answer is no. Any damage to your heart, such as scarring, is usually irreversible. However, keeping your blood pressure under control will still lower your risk of heart disease and can prevent further damage. Even if you keep your blood pressure within the normal range, you still have about twice the risk² of somebody who has never been treated for high blood pressure.

Lowering your blood pressure also reduces your risk of stroke and helps protect other organs, like your kidneys and eyes, from damage.

The lowdown

High blood pressure can damage your heart and greatly increase your risk of heart disease, including heart failure and heart attack. These cardiac events can be fatal, so it is vital to control your blood pressure. While damage to your heart is mostly irreversible, maintaining your blood pressure will still lower your risk of future health problems.

Eating a heart-healthy diet can help keep you from developing both high blood pressure and heart disease in the first place. Two simple interventions that can help are to stop smoking and reduce the amount of sodium you consume, and your doctor can guide you further in both of these areas.

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