Hypertensive heart disease — master index¶

Last curated: 2026-10-20 · status: swept 2026-10-20, awaiting independent audit; 9 pages draft (including 2 pending 2026 ESC guideline synthesis)

The condition in five sentences. Hypertensive heart disease (HHD) is a causal clinical construct linking sustained elevated blood pressure to cardiac structural or functional injury, but it lacks one universally operationalized phenotype (Nwabuo 2020, PMID 32016791). Its continuum includes LV remodeling and hypertrophy, fibrosis, impaired relaxation and strain, left-atrial disease, AF, HFpEF and sometimes HFrEF, while obesity, CKD, sleep apnea and primary aldosteronism can amplify or mimic the pathway (Gallo 2024, PMID 38928371; Monticone 2018, PMID 29129575). GBD “HHD” is a modeled cause-of-death and disability category rather than a count of people with imaging-defined disease, so burden estimates cannot be substituted for clinical prevalence (Yang 2023, PMID 37698022; GBD 2021 Causes, PMID 38582094). BP lowering prevents cardiovascular events, and trials support intensive control for selected, correctly measured and tolerating populations, but kidney, electrolyte and symptomatic harms remain part of net benefit (Ettehad 2016, PMID 26724178; SPRINT 2015, PMID 26551272). The field’s decisive next step is to prove that imaging or biomarker staging changes treatment and outcomes, rather than merely predicting them (Sharp 2026, PMID 41771092; Lee 2025, PMID 40739095).

Start here: overview · Unresolved frontier: OPEN-QUESTIONS · Build history: LOG

Audit snapshot¶

Component	Count / state
Canonical wiki pages	18 / 18 written
Page length	160–215 lines
Distinct PMIDs per page	25–38
Unique PubMed papers in master bibliography	301
ClinicalTrials.gov identifiers	32
Landmark deep notes	6
Guideline registry	Built
Statistics register	Built
Patient-voice layer	Built
Independent condition audit	Completed 2026-08-29; 2026-08-31 sweep independently audited the same day; 2026-10-13 and 2026-10-20 sweeps not yet audited; 2 current-guideline gaps remain flagged

The audited status means all planned artifacts exist and every citation and registry identifier was re-resolved against live records in a separate audit pass. All canonical pages passed structural, bibliographic and claim-scope review on 2026-08-29. The ten pages edited by the literature sweep of 2026-08-31 were independently re-audited against live records the same day. Eight returned to curated; heart-failure-management.md and guidelines.md remain draft because the indexed 2026 ESC heart-failure and cardiovascular-disease/CKD guidelines have not yet been read and synthesized.

Reading paths¶

Rapid clinical orientation¶

Mechanism to clinical syndrome¶

Evidence and research frontier¶

Prevention, equity and lived experience¶

Canonical pages¶

File	Scope	Status
overview.md	Definition, attribution, remodeling, prevention and treatment map	curated
nosology-and-attribution.md	Clinical phenotype versus GBD/death-certificate construct and coding limitations	curated
epidemiology-and-burden.md	Global and regional burden, mortality, sex and age patterns	draft
ventricular-remodeling.md	Hypertrophy geometry, fibrosis, microvascular disease and systolic transition	curated
diastolic-dysfunction-and-hfpef.md	Relaxation, filling pressure, atrial disease and HFpEF continuum	curated
arrhythmia-and-atrial-remodeling.md	AF, conduction disease and ventricular-arrhythmia evidence	draft
diagnosis-and-phenotyping.md	BP confirmation, ECG, echo, CMR and differential diagnosis	draft
secondary-hypertension-and-modifiers.md	Aldosteronism, CKD, obesity, sleep apnea and endocrine causes	curated
blood-pressure-targets.md	Office/out-of-office measures, intensive-control trials and frailty	draft
pharmacologic-prevention-and-regression.md	Drug classes, LVH regression, resistant hypertension and adherence	draft
lifestyle-and-population-prevention.md	Sodium, DASH, weight, activity and policy interventions	curated
heart-failure-management.md	HFrEF/HFpEF treatment after clinical HF develops	draft
outcomes-and-risk-stratification.md	HF, AF, stroke, coronary events and mortality prediction	curated
guidelines.md	U.S., European, global and national guidance disagreements	draft
biomarkers-and-imaging-markers.md	Natriuretic peptides, troponin, strain, fibrosis and CMR phenotypes	draft
clinical-trials-landscape.md	Targets, devices, remodeling and prevention trials	draft
patient-experience-and-advocacy.md	Silent progression, adherence, access and lived burden	curated
red-flags-and-safety-concerns.md	Emergency syndromes, differential diagnoses and medication hazards	curated

Literature layer¶

Artifact	Purpose	State
BIBLIOGRAPHY.md	301-paper master bibliography with tags and cited-by mapping	audited through 2026-08-31; 43 entries added by the 2026-10-13 and 2026-10-20 sweeps await audit
Dahlöf 2002 LIFE note	Phenotype-enriched BP strategy and outcomes	audited
THESUS-HF II note	Clinically assigned HHD as the leading acute-HF cause in the 17-country aggregate cohort	audited
SPRINT 2015 note	Intensive target benefits and harms	audited
PATHWAY-2 note	Resistant-hypertension fourth-line therapy	audited
SSaSS note	Salt substitution and hard outcomes	audited
REVERSE-LVH note	CMR fibrosis regression proof-of-concept	audited
Guideline registry	Worldwide comparison, disagreements, superseded chains and watch list	audited through 2026-08-31; subsequent sweep changes await audit
Statistics register	Denominator-aware effects, confidence intervals and conflicts	audited through 2026-08-31; subsequent sweep changes await audit
Patient-voice README	Scope, ethics, minimum dataset and evidence limits	audited
Organizations	Live-checked public and advocacy resources	audited through 2026-08-29; subsequent sweep changes await audit
Themes	Evidence-linked patient-experience synthesis	audited
Sources	Annotated qualitative source register	audited through 2026-08-31; subsequent sweep changes await audit

Curation state and known limits¶

This condition was fully audited on 2026-08-29 and the 2026-08-31 sweep was independently re-audited that day. The October sweeps await independent audit. The current bibliography contains 301 papers; 32 ClinicalTrials.gov identifiers are tracked in condition prose. Nine canonical pages are curated and nine are draft. The 2026-10-20 sweep adds seven bibliography records, edits biomarkers, regional guidance and the trial snapshot, and sharpens three open-question entries; see LOG.

Direct HHD-specific patient-experience and clinical-prevalence evidence remain limited. heart-failure-management.md and guidelines.md retain the unresolved 2026 ESC HF/CVD-CKD full-text synthesis flag: publisher retrieval still failed on 2026-10-20. The retrieved Africa hypertension guideline informs a separate regional update; it does not resolve those European guideline gaps.