Finally, atrial fibrillation is the most common arrhythmia induced by hypertension. Despite some overlap, it usually begins in the paroxysmal form and becomes permanent later on; in some cases, an embolic event can develop as the main complication of this rhythm disturbance. Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003;289:2363-9. If left untreated hypertensive heart disease can lead to the following potentially life-threatening conditions: Classical imaging features of hypertensive heart disease include left ventricular hypertrophy and left atrial enlargement which can be visualized in echocardiography, cardiac CT and cardiac MRI. Plain radiograph

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Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular mobidity and mortality. Kidney Int. 2011;27:250-257. Future refinement of this classification may cover also vascular changes (cerebral, peripheral, renal) also very frequent in hypertensive patients and ususally a challenge for practitioners. 6 - Self training Adequate pharmacological antihypertensive therapy is the mainstay in the management leading to improved diastolic function and cardiovascular outcomes.

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FHN Trial Group. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287-2300. Pauly RP, Gill JS, Rose CL, et al. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009;24:2915-2919. Daugirdas JT, Blake PG, Ing TS. Handbook of Dialysis. Philidelphia, PA: Lippincott, Williams, and Wilkins; 2007. A graded and easy-to-use classification of hypertensive heart disease, similar to the widely used TNM staging for cancer, is proposed. The acronym VIA stands for left ventricle (V), myocardial ischaemia (I), and atrial fibrillation (A).

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Mavrogeni S, Katsi V, Vartela V et al. The Emerging Role of Cardiovascular Magnetic Resonance in the Evaluation of Hypertensive Heart Disease. BMC Cardiovasc Disord. 2017;17(1):132. doi:10.1186/s12872-017-0556-8 - Pubmed Pinciaroli AR. Restuls of daily hemodialysis in Catanzaro: 12-year experience with 22 patients treated for more than one year. Hemodial Int. 1998;2(1):12-17.Heidenheim PA, Muirhead N, Moist L, Lindsay RM. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003;42(S1)(S1):S36-S41.

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Iriarte MM, Murga N, Sagastagoitia JD, Morillas M, Boveda J, Molinero E, et al. Classification of hypertensive cardiomyopathy. Eur Heart J 1993;14(Suppl J):95-101. Classical findings on examination include an abnormally sustained, enlarged or displaced apical impulse and an S 4 gallop suggesting left ventricular hypertrophy 3. Kraus M, Finkelstein FO, Daoui R, et al. Short Daily Hemodialysis (SDHD) improves overall Quality of Life (QOL) and physicial intimacy: interim results from the FREEDOM study. Abstract presented at the American Society of Nephrology Conference, 2011. AH: Arterial hypertension; EF: left ventricular ejection fraction; FC: functional capacity; LV: left ventricle; LVH: left ventricular hypertrophy Hall YN, Larive B, Painter P, et al. Effects of six versus three times per week hemodialysis on physical performance, health, and functioning: Frequent Hemodialysis Network (FHN) randomized trials. Clin J Am Soc Nephrol. 2012;7(5):782-794.

Jaber BL, Lee Y, Collins AJ, et al. Effect of daily hemodialysis on depressive symptoms and postdialysis recovery time: interim report from the FREEDOM (Following Rehabilitation, Economics and Everyday-Dialysis Outcome Measurements) Study. Am J Kidney Dis. 2010;56(3):531-539. Kostis JB. From hypertension to heart failure: update on the management of systolic and diastolic dysfunction. Am J Hypertens 2003;16(Suppl 2):18S-22S. The first definition of HHD was proposed in 1979 by the New York Heart Association. Hypertensive heart disease was defined as an anatomofunctional alteration characterized by left ventricular hypertrophy (LVH) and cardiac failure in patients with systemic hypertension19. With this definition, HHD was made equivalent to heart failure. Female patient. 83 years-old. Isolated systolic hypertension. Admitted for acute pulmonary oedema. Permanent atrial fibrillation. Echocardiogram shows EF= 38%.

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Kraus MA, Cox CG, Summitt CL, et al. Work and travel in a large Short Daily Hemodialysis (SDHD) program. Abstract presented at American Society of Nephrology Annual Conference, 2007. Struijker Boudier HA, Cohuet GM, Baumann M, Safar ME. The heart, macrocirculation and microcirculation in hypertension: a unifying hypothesis. J Hypertens Suppl 2003;21(Suppl 3):S19-23. Schumann C, Jaeger N, Kramer C. Recent Advances in Imaging of Hypertensive Heart Disease. Curr Hypertens Rep. 2019;21(1):3. doi:10.1007/s11906-019-0910-6 - Pubmed Features : Three stages in AH according to end-organ damage, including heart (1=no; 2= signs of involvement; 3= clinical complications), Three groups according to LVH (1= dispro-portionate septal hypertrofia; 2= concen-tric LVH; 3= eccentric LVH 3a, dilated;3b, non dilated), Four degrees according to LVH (1= no; 2=early; 3= established; 4= heart failure), Four groups according to LVH (1= normal LV; 2= concentric remodeling of LV; 3= concentric LVH; 4= eccentric LVH), Four groups according to physiopathological concepts (1= diastolic dysfunction; 2= LVH 2a, with normal FC; 2b, with impaired FC; 3= heart failure with normal EF; 4= heart failure with depressed EF)

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All hemodialysis therapies also involve the use of medical devices that introduce the potential for additional risks including air entering the bloodstream, damage of red blood cells, inflammatory reactions, blood chemistry imbalances, blood loss due to clotting of the blood tubing set or accidental blood line disconnection or other leak, allergic reactions, and excess warming or cooling of the dialysate. In addition, dialysis patients may have other underlying diseases that may, in some cases, make it more difficult for them to manage their hemodialysis treatments. Consequently, a comprehensive definition of hypertensive heart disease should include the most important alterations documented in these three territories.