Hypertensive heart disease refers to heart conditions that develop as a result of uncontrolled high blood pressure. These heart conditions include enlargement of the left ventricle of the heart, heart failure, irregular heart rhythms (arrhythmias) and heart attacks (myocardial infarction). Uncontrolled high blood pressure can also lead to strokes and kidney failure.

Hypertensive heart disease is a cardiovascular condition related to sustained hypertension. Hypertension refers to an intermittent or sustained elevation in diastolic or systolic blood pressure. Hypertension is classified as essential and secondary.

Development results from untreated hypertension where there is an increase in peripheral resistance resulting from vasoconstriction or narrowing of peripheral blood vessels. The cause of essential hypertension is unknown. High blood pressure is one of the complications of coronary artery disease. When the blood pressure is elevated, it forces the heart to work harder to maintain blood flow to tissues. The heart enlarges in order to keep blood flowing out of the heart into narrower vessels that have increased resistance, resulting in left ventricular hypertrophy.

Manifestations of the condition include: enlargement of the heart; a thickening of the walls of the heart; congestive heart failure (CHF), swelling of the ankles, breathlessness, weakness and fatigue; left ventricular hypertrophy; ventricular or atrial arrhythmias, or ischemic heart disease or both; and stroke.

The functional abilities of cardiac patients can be classified in terms of metabolic equivalents (METs). The classification is generally as follows:

• Light to medium housework is 2 to 4 METs

• Heavy housework or yard work is approximately 5 to 6 METs

• Strenuous activity would be 7 to 10 METs, etc.

To determine the limitations on patient's functional abilities, the METs are considered in accordance with what symptoms are exhibited when the activities are carried out. For example, if a patient is performing activity at the 2 to 4 MET level and experiences dyspnea, fatigue, dizziness or fainting, the patient is considered to have low functional abilities.

Urinalysis, blood studies, electrocardiogram (EKG), coronary arteriography, echocardiogram, and chest x-ray constitute tests used for the condition.

The focus in treatment is to cope with the underlying hypertension, and to control the manifested heart disease.

Residuals related to the condition include: enlarged heart, thickened heart walls, reduced activity level, and sudden death.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [ 38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309 (a) [chronic disease].

• If a Veteran is a former prisoner of war, this disease shall be service connected if manifest to a degree of disability of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [ 38 CFR 3.309 (c) Disease subject to presumptive service connection].

Note

• Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it.

• One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms.

• For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.