Hypertensive cardiovascular disease affects multiple organs, including the heart, lungs, and kidneys, as well as the arteries in other tissues.

With hypertension (or high blood pressure), blood flow is decreased through constricted arteries (increasing the pressure against the arterial walls). The heart must then work harder to continue to push the blood through thickened and constricted arteries. Like gaining skeletal muscle through weight-bearing exercises at the gym, the heart muscle will also thicken or hypertrophy with the increased work. This can be seen at autopsy by increased heart weight, increased wall thickness, and microscopic changes. The hypertrophied muscle can however also affect the cardiac conduction system that causes the heart chambers to beat synchronously. This can cause a sudden arrhythmia or abnormal heart rhythm. This could just cause the heart to ‘skip a beat’ and then go back into normal sinus rhythm, but sometimes the return to normal sinus rhythm may not occur immediately or at all. This can cause persistent arrhythmias that cause symptoms such as dizziness, shortness of breath, or palpitations, but other arrhythmias are more serious, such as ventricular fibrillation, that will shortly lead to unconsciousness and death.