How Hypertension Leads To Heart Failure And The Warning Signs You Should Know

High blood pressure or hypertension is a common condition affecting over 100 million American adults.¹ The higher your blood pressure levels, the higher your risk of developing other health problems, including heart failure, heart disease, heart attack, and stroke. This article looks at how hypertension causes heart failure and the warning signs you should look out for.

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Hypertension: symptoms, causes, and risk factors

High blood pressure (HBP) is a condition where the pressure of blood against the artery walls is too high, which can cause a variety of health issues. Some people with high blood pressure have no symptoms or signs even when the blood pressure is alarmingly high.

However, other people with hypertension may experience the following symptoms:

  • Headaches

  • Shortness of breath

  • Nosebleeds

  • Lightheadedness


For most people, there is no clear cause of high blood pressure. However, some people could be experiencing hypertension caused by an underlying condition and medications such as:

Risk factors

Risk factors for developing hypertension include:

Age: the risk of developing hypertension increases when you get older.

Race: high blood pressure is more prevalent among people of African heritage.²

Family history: the risk of developing high blood pressure increases if one family member has it.

Being overweight or obese: the more weight you put on, the more blood you need to supply oxygen and nutrients to the body tissues. As the amount of blood flow in your vessels increases, so does the pressure on the artery wall.

Lack of physical activity: inactive people tend to have higher heart rates.

Using tobacco: smoking and chewing tobacco can increase your blood pressure. Additionally, the chemicals in tobacco can damage the lining of your artery walls and increase your risk of heart disease.

Using too much salt in your diet: too much salt causes your body to retain fluid which eventually increases blood pressure.

Inadequate potassium in diet: potassium balances the amount of sodium in cells, and a proper balance of potassium is essential for the appropriate functioning of the heart. Losing too much potassium due to dehydration or inadequate potassium intake in your diet leads to sodium build-up in your blood.

Stress: High levels of stress tend to cause an increase in blood pressure.

Too much alcohol: heavy drinking can damage your heart.³ Having more than two drinks a day for men and one drink a day for women may raise your blood pressure.

Chronic conditions: certain chronic conditions can also increase the risk of hypertension. These conditions include diabetes, kidney disease, and sleep apnea.

How does hypertension affect the heart?

Hypertension can make the arteries less elastic, thereby damaging them and causing a decrease in the flow of blood and oxygen to the heart. This can eventually lead to heart disease, heart attack, and heart failure.

How does hypertension cause heart failure?

Heart failure is a condition where your heart cannot provide an adequate blood supply to the body. The following are the ways hypertension causes heart failure:

  • Adding to the heart's workload: high blood pressure adds to your heart's workload. This is due to the narrowing of less elastic arteries, making it more difficult for the blood to travel smoothly and easily throughout the body. This causes the heart to work harder to deliver blood to every organ in your body. Eventually, an overwhelmed heart may begin to fail.

  • Enlargement of the heart: with time, the higher workload leads to an enlarged heart. The heart is forced to thicken and become larger to handle the increased demands. Although it can still pump the blood, the heart becomes less effective. The larger the heart becomes, the harder it has to work to deliver enough blood throughout your body.

  • Damage to the arteries: high blood pressure can damage the arteries' inner lining cells, leading to fats from your diet collecting in the affected arteries. As a result, the artery walls become less elastic and can interfere with normal blood flow.

  • Aneurysm: with time, the higher pressure of blood within the arteries could weaken the vessel and cause some sections of the wall to enlarge and form a bulge. Aneurysms are common in the aorta, the body's largest artery—severe internal bleeding results from a ruptured aneurysm. 

Heart failure signs and symptoms

Heart failure may be chronic or occur unexpectedly. The following are some of the common signs and symptoms of heart failure:

  • Fatigue and general weakness

  • Shortness of breath while doing an activity or even when lying down

  • Rapid or irregular heartbeat

  • Swelling in the ankles, legs, and feet

  • Chest pain 

  • Decreased alertness and difficulty concentrating

  • Nausea and loss of appetite.

  • Rapid and unexplained weight gain due to fluid build-up

  • Swelling of the abdomen

  • Persistent cough or wheezing with pink or white blood-tinged mucus

How does hypertension cause a heart attack?

The excess strain and damage from high blood pressure may cause the coronary arteries to become narrowed with time, primarily from the build-up of fat and cholesterol. Blood clots may start forming as the arteries harden with fat and cholesterol.

The blood clots in the arteries interrupt the flow of the blood through the heart muscle, starving the muscle of crucial oxygen and nutrients. This eventually leads to a heart attack.

How does hypertension cause congestive heart failure?

Research reveals that more than 5 million people have congestive heart failure in the United States.⁴ Congestive heart failure is a severe condition where the heart doesn't pump blood efficiently enough to meet the body’s demands.

Hypertension causes the heart muscle to become less able to contract. Because the heart muscles can't keep up with the body's demand, blood returns to the heart faster than it can be pumped out. Less pumping translates to inadequate oxygen-rich blood reaching the body's organs.

Your body will try to compensate in other ways, including:

  • Increasing heart rate: the heart will try to beat faster to take less time for the refilling after it contracts. However, the extra effort can cause heart palpitations with time.

  • Enlargement of the heart: the heart may also enlarge to make room for more blood. The enlargement makes the heart less efficient, leading to congestive heart failure in the long run.

When should you see a doctor or seek emergency medical care?

It is essential to see the doctor immediately if you think you are experiencing the signs or symptoms of heart failure. Call 911 for emergency help if you experience the following symptoms:

  • Chest pain

  • Fainting and extreme weakness

  • Sudden severe shortness of breath

  • Coughing up white or pink foamy mucus

  • Rapid and irregular shortness of breath

Although these signs could be due to heart failure, there are several other causes, including heart disease and lung conditions. You should not try to diagnose yourself. Health professionals will stabilize your heart and determine whether the symptoms are due to heart failure or not.

Heart failure: diagnosis and treatment

The doctor diagnoses your heart failure by taking your medical history, reviewing your signs or symptoms, and performing a physical examination.  The following are some of the diagnostic methods to determine heart failure:

  • Physical exam: The doctor may check your lungs for signs of lung congestion and your heart for sounds that suggest heart failure. A health care professional will also examine the veins in your neck for fluid overload and check whether there is fluid build-up in your legs and abdomen.

  • Blood tests: Blood tests can indicate heart failure.

  • Chest x rays: X-ray images assess for fluid buildup in the lungs.

  • Electrocardiogram (ECG): ECG is a test that gives information about heart rhythm and blood flow through the heart.  


Treating the underlying cause can reverse heart failure. The initial treatment of heart failure involves using oral and/or intravenous medications that help push fluid out of the body, by increasing the need for urination.  

However, in more severe cases, the treatment of heart failure involves balancing the proper medication and the use of devices to help the heartbeat and contract properly. Surgery and other procedures to cardiac implant devices may also be used to treat the underlying issue that led to heart failure.

Common medications used to treat heart failure include:

  • Angiotensin-converting enzyme (ACE) inhibitors

  • Angiotensin II receptor blockers

  • Beta-blockers.

  • Diuretics.

  • Aldosterone antagonists.

  • Positive inotropes. 

Avoiding heart failure: What can you do to prevent or manage hypertension?

Preventing or managing high blood pressure can lower your risk for heart failure. Most people with high blood pressure can lower their blood pressure into a healthier range by making lifestyle changes. Practice the following healthy living habits:

Eat a healthy diet

Choosing healthy meal and snack options can be an effective way to avoid high blood pressure and its complications, including heart failure.

Choose a variety of food rich in potassium, fiber, and protein and reduce salt and saturated fat in your diet. You should also include plenty of fresh fruits and vegetables in your diet.

Maintain a healthy weight

Being overweight or obese increases the risk for high blood pressure substantially. Doctors often determine whether your weight is in a healthy range by calculating your body mass index (BMI).

If you are overweight, talk with your health care team about the effective ways to reduce weight to healthy levels. This may include getting regular physical activity and eating healthy foods.

Increase physical activity

Physical activity is an effective way to reach a healthy weight and lower blood pressure.

Experts⁵ recommend that adults get at least 2 hours and 30 minutes of moderate-intensity exercise each week, which translates to 30 minutes of exercise each day for five days a week. Children and adolescents should get one hour of exercise each day.

Avoid smoking

Smoking raises your blood pressure and puts you at risk for heart failure, stroke, and heart attack. If you have never smoked, don't start. If you smoke, quit the habit to lower your risk for heart failure. Seek help from your doctor about ways to stop smoking.

Limit alcohol intake

Heavy drinking raises blood pressure and puts you at risk for heart failure. The CDC's Alcohol and Public Health⁶ website recommends that men have a maximum of two drinks a day and women no more than one drink per day.

Get adequate sleep

Getting sufficient sleep⁷ is crucial for your overall health. Inadequate sleep is linked to an increased risk of heart disease, high blood pressure, and stroke. Sleep helps keep your heart and blood vessels in a healthy state.

The lowdown

47% or 116 million adults⁸ in the USA have hypertension. Uncontrolled hypertension is a leading risk factor for developing heart failure. The narrowing and blocking of blood vessels caused by hypertension increase the risk of developing heart failure.

Essentially, when the pressure in the blood vessels is too high, the heart is forced to pump harder than usual to keep blood circulating optimally. This eventually takes a toll on the heart forcing the chambers to get larger and weaker.

People with hypertension can use lifestyle modifications with prescription medication to manage their blood pressure and reduce the risk of heart failure.

  1. High blood pressure–Understanding the silent killer | U.S. Food and Drug Administration

  2. Why do black americans have higher prevalence of hypertension? (2011)

  3. Alcohol: Does it affect blood pressure? | Mayo Clinic

  4. Congestive heart failure: Prevention, treatment and research | Johns Hopkins Medicine

  5. Current Guidelines |

  6. Alcohol and public health | Centers for Disease Control and Prevention

  7. How does sleep affect your heart health | Centers for Disease Control and Prevention

  8. Facts about hypertension | Centers for Disease Control and Prevention

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