Abstract
Objective: This integrative literature review aimed to elucidate the atypical structural, functional, and epidemiological features of hypertensive heart disease (HHD).
Methodology: A comprehensive literature search was conducted, gathering case reports that illustrated the atypical manifestations of HHD without any age restrictions. Data from these reports were retrospectively analyzed and thematically categorized to assess patient demographics and clinical presentations.
Results: Distinct left ventricular (LV) phenotypes were identified, revealing variability in myocardial dysfunction and fibrosis, indicative of the atypical nature of HHD. Structural changes in the extracellular matrix (ECM) were linked to LV remodeling and progression to congestive heart failure (CHF). Functionally, altered circumferential strain and aortic distensibility, as well as abnormal matrix metalloproteinase profiles, were associated with LVH and diastolic dysfunction. Elevated tissue inhibitor of metalloproteinases (TIMP-1) levels emerged as a potential atypical biomarker for CHF. Global trends showed an increase in HHD prevalence with a concurrent decrease in mortality and disability-adjusted life years (DALYs), suggesting improvements in management.
Conclusion: The review concludes that atypical presentations of HHD are characterized by a diverse range of LV phenotypes and structural changes that lead to functional impairment. Elevated TIMP-1 levels may serve as a predictive biomarker for CHF. Despite an increase in prevalence, global mortality and DALY trends indicate better disease management.

Key words: Atypical presentations, Hypertensive heart disease, Idiopathic intracranial hypertension, Genetic predisposition, Clinical diversity.