Heart Failure With Hypertension

Overview

Heart failure does not mean the heart has stopped. It means the heart is not pumping as well as it should, so it can struggle to send enough blood around the body or fill with blood properly. Hypertension means high blood pressure. When the two happen together, years of high blood pressure may have made the heart muscle stiff or weak. The body may then hold on to extra salt and fluid, which can cause breathlessness and swelling.

Heart failure is common, especially in older adults. High blood pressure is very common and is one of the most important causes of heart failure.

It is more likely as people get older and in people with long-standing high blood pressure, heart disease, diabetes, kidney disease, or obesity. It can affect adults of all ages, but it is less common in younger people.

Symptoms

Common symptoms

• Breathlessness when walking, climbing stairs, or being active
• Breathlessness when lying flat, or needing extra pillows to sleep
• Waking at night feeling breathless
• Tiredness or low energy
• Swelling in the feet, ankles, or legs
• A swollen or bloated belly
• Quick weight gain from extra fluid
• A cough, especially when lying down
• Dizziness or feeling light-headed
• Finding it harder to do usual activities

Symptoms in children

• Heart failure is uncommon in children and is usually caused by a heart problem present from birth or another serious illness.
• Signs can include fast breathing, sweating during feeds, poor feeding, poor growth, and unusual tiredness.
• A child with these signs needs to be checked by a healthcare professional.

Symptoms in older adults

• Symptoms may be less typical and can include confusion, falls, loss of appetite, or marked tiredness.
• Breathlessness or swelling may be mistaken for normal ageing or other conditions.
• Regular reviews and asking about changes in function can help spot problems earlier.

Causes

Main causes

• Long-standing high blood pressure, which can stiffen or damage the heart muscle over time
• Coronary artery disease or a previous heart attack
• Heart valve problems
• Cardiomyopathy, meaning a disease of the heart muscle
• Heart rhythm problems
• Other conditions such as kidney disease, diabetes, obesity, sleep apnoea, or heavy alcohol use

Risk factors

• Older age
• Family history of heart disease or heart failure
• Smoking
• A diet high in salt and processed foods
• Not being physically active
• Obesity
• Diabetes
• Kidney disease
• Sleep apnoea, where breathing stops briefly during sleep
• Drinking too much alcohol

When to see a doctor

See a doctor urgently if:

• Worsening breathlessness, swelling, or quick weight gain
• New chest pain, fainting, or palpitations
• Being unable to do usual activities because of breathlessness or tiredness
• A fever or infection that makes heart symptoms worse

Book a routine appointment if:

• New or mild ankle swelling
• Blood pressure that is often higher than your target
• Questions about your medicines or side effects
• Review of your self-care plan, vaccinations, and regular checks
• Feeling more tired or less able to exercise than usual

Diagnosis

Your doctor will ask about your symptoms, past health, and medicines, and will examine you. They may check your blood pressure, listen to your heart and lungs, and look for swelling. Tests help confirm heart failure, find the cause, and guide treatment.

Tests that may be done

• Blood tests to check kidney function, blood count, thyroid, and other causes
• A blood test for a heart strain marker, which can help support the diagnosis
• An ECG, which records the heart's electrical activity
• An echocardiogram, an ultrasound scan of the heart
• A chest X-ray
• Blood pressure monitoring
• A heart rhythm monitor if an irregular heartbeat is suspected

What to expect at your appointment

Diagnosis may take more than one visit. Some tests are quick, while others need an appointment. Ask your care team to explain what each test is for and when you will get results. Bring a list of your medicines and questions.

Treatment

Heart failure with high blood pressure is usually managed with a combination of medicines, self-care, and regular review. Treatment aims to lower blood pressure, reduce the heart's workload, remove extra fluid, and protect the heart and kidneys. It can ease symptoms and help people stay active.

Self-care at home

• Weigh yourself daily at the same time and write it down; contact your care team if your weight rises quickly
• Limit salt and avoid adding salt at the table
• Take medicines exactly as prescribed and do not stop them without advice
• Keep a note of your symptoms and bring it to appointments
• Ask your pharmacist before taking over-the-counter medicines, as some can worsen fluid build-up
• Attend regular reviews and blood tests
• Stay active within your comfort, and pace yourself
• Avoid smoking and limit alcohol

Medical treatments

Doctors may prescribe medicines that lower blood pressure, help remove extra fluid, slow the heart's workload, or protect the heart. Your team may adjust treatment over time and check kidney function and salt levels with blood tests. Treatment is tailored to you and may change as your symptoms and test results change. Always ask your healthcare provider before starting or stopping any medicine.

When is surgery considered?

Surgery is not usually the main treatment for heart failure with high blood pressure. If tests show a valve problem, blocked heart arteries, or a heart rhythm problem that is causing or worsening heart failure, a procedure or device may be considered. Your specialist team would discuss the benefits and risks with you.

Living with this condition

Plan your days with a mix of activity and rest. Keep your appointments, track your weight and symptoms, and follow any action plan your care team gives you. Ask for help with chores or shopping if you need it, and tell your team early if things change.

Lifestyle tips

• Stop smoking and avoid second-hand smoke
• Keep to a healthy weight
• Limit alcohol
• Get enough sleep and treat sleep apnoea if you have it
• Stay socially connected and ask for support when needed
• Follow your care plan for blood pressure, diabetes, and kidney health

Diet and exercise

Eat a balanced diet with plenty of vegetables, fruit, whole grains, and lean protein. Limit salt and highly processed foods. Regular gentle activity, such as walking, can help your heart and mood. Ask your care team about a cardiac rehabilitation programme, and check before starting a new vigorous exercise plan.

Mental health and emotional wellbeing

It is common to feel worried, low, or frustrated when living with a long-term heart condition. These feelings are valid, and support is available. Talking to your care team, friends, or a counsellor can help. If you ever feel you might harm yourself or are in crisis, contact your local emergency number or a local crisis line straight away.

Prevention

The risk can be lowered, and early heart failure can be better managed. Not all cases are preventable, but controlling blood pressure, treating heart disease, and healthy living make a big difference.

Vaccines

Ask your healthcare team which vaccinations are recommended for you. People with heart conditions are often advised to have yearly flu and pneumonia vaccines, and some may be advised to have COVID-19 vaccination.

Screening programmes

Regular blood pressure checks are important. Adults should have blood pressure measured at health checks. People with high blood pressure need regular monitoring and checks for heart, kidney, and diabetes risk.

Complications

If left untreated

• Worsening breathlessness and fluid build-up
• Kidney problems
• Irregular heart rhythms
• More hospital stays
• Anxiety and depression
• Rarely, a sudden serious worsening of heart failure

Long-term outlook

With early diagnosis, treatment, and support, many people live well for years. Heart failure is serious, but it does not mean an immediate decline. Treatment can ease symptoms and help you stay active. Keep your reviews and seek help early if symptoms change.

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