Q. Can hypertension cause dilated cardiomyopathy?

Hello doctor,

I have a medical question actually. There is a 30-year-old obese female with no known history who comes to the emergency room. She presents with a 2-month history of shortness of breath and pedal edema. When she comes to the emergency room she is found to be in a hypertensive emergency with pressures of 190/110. She was given Lasix in ER and her pressures responded well. CT angio chest and CXR showed mild pericardial and b/l pleural effusions. Her BNP was elevated at 1000. An echo was done which showed LVEF of 20 to 25 % with severe concentric LVH. The echo showed dilated cardiomyopathy. Given her age group, we did an extensive workup for her HTN and her CHF, including lupus, RA, viral antibodies, (echo adenovirus), b/l renal artery stenosis, fibromuscular dysplasia, pheochromocytoma, etc. Everything was negative.

It seems that she may have had severe diastolic dysfunction due to underlying untreated HTN which was undiagnosed. But my question is the systolic heart failure with dilated cardiomyopathy. What explains that in this lady? Can hypertension in itself cause dilated cardiomyopathy? If so, would the echo show both a dilated LV and severe concentric LVH? Or is it that she may have had a viral infection of some sort which slipped her into dilated cardiomyopathy and caused her to go into HF? I know this is a medical question and I am not giving the full information but I would love if you can explain this to me. Thanks.