Borderline hypertension or subclinical hypertension is a substrate for myocardial dysfunction, and patients can go for a long time with hypertension that isn’t clinically recognized, according to a heart failure specialist at Norton Heart & Vascular Institute.

Additionally, high hypertension effects can be accelerated to a cardiomyopathy.

“When we start thinking about the burden of hypertension, yes, we’re concerned about stroke and kidney function, but really, what we’re hoping to prevent is a diagnosis of heart failure,” said Kelly C. McCants, M.D., executive medical director of the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program and executive director of the Institute for Health Equity, a Part of Norton Healthcare.

“When you see borderline hypertension, particularly in a young patient who’s African American, you should start medical therapy as early as possible,” Dr. McCants said in a recent continuing medical education opportunity, “Clinical Case Review: The Dangers of Subclinical Hypertension — The Great Mimicker.”

Clinicians need to keep in mind that borderline hypertension in an exam room will be higher when the patient is stressed or exercising, with systolic blood pressure increasing significantly if not doubling.

Younger patients may be reluctant to take medication. It can be helpful to explain to someone who has hypertension in their 30s that by the time in they’re in their 60s they are more likely to develop heart attack, stroke, heart failure, kidney failure, eye issues and other complications.

There can be fairly significant left ventricular hypertrophy with long-standing borderline hypertension.

“For patients who have left ventricular hypertrophy, ACE inhibitors and angiotensin receptor blockers are your drugs of choice,” Dr. McCants said. “We have the ability to reverse that remodeling. If they take two medicines now, they’ll live longer and be less likely to have one of those feared complications.”