In essential hypertension with a blood pressure of 200/120 mm Hg, which change would NOT typically occur?

• A. Decreased size of the heart muscle
• B. Hypertrophy of the left ventricle
• C. Increased arterial stiffness
• D. Increased risk of heart failure

Answer: (A)

The main concept here is how the heart and arteries adapt to chronic high blood pressure. When afterload is persistently elevated, the heart thickens its muscle to generate the higher pressures needed to eject blood, a response called left ventricular hypertrophy. This concentric hypertrophy helps keep wall stress in check despite the high pressure, but it also sets the stage for eventual dysfunction and heart failure if the hypertension remains uncontrolled. Arterial stiffness increases as the vessels remodel—collagen replaces some elastic tissue—leading to greater systolic pressure and pulse pressure. Over time, those changes raise the risk of heart failure because the heart and vessels are less able to accommodate normal blood flow and pressures.

The change that would not typically occur is a decrease in the size of the heart muscle. Instead, the heart muscle tends to enlarge in response to the chronic pressure overload. So, left ventricular hypertrophy, increased arterial stiffness, and higher risk of heart failure are expected consequences of severe essential hypertension, while a reduction in heart muscle size would be atypical.