ICD-10 Code: I11.9

Hypertensive heart disease encompasses the cardiac consequences of chronic systemic hypertension, representing the heart's adaptive and maladaptive responses to sustained pressure overload. The primary manifestation is left ventricular hypertrophy (LVH), where increased afterload stimulates myocyte hypertrophy and interstitial fibrosis, detected by echocardiography (increased wall thickness, increased LV mass) or ECG (voltage criteria, strain pattern). Additional manifestations include diastolic dysfunction (impaired relaxation and filling), left atrial enlargement, and accelerated coronary atherosclerosis. Patients may be asymptomatic or present with exertional dyspnea, angina, arrhythmias (especially atrial fibrillation), or reduced exercise tolerance. Long-term, uncontrolled hypertensive heart disease progresses to heart failure with preserved ejection fraction (HFpEF) or eventually systolic dysfunction. This code (I11.9) is used when hypertensive heart disease is present but the patient does NOT currently have clinical heart failure. If heart failure develops, the code changes to I11.0. The causal relationship between hypertension and heart disease is assumed per ICD-10-CM guidelines when both are documented; separate coding is not required.