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Hypertension exerts long-term effects on the heart primarily through increased systemic pressure, which places a higher workload on the heart. Over time, this chronic elevation of blood pressure causes the heart muscle, particularly the left ventricle, to adapt by thickening, a condition known as left ventricular hypertrophy.

The heart must generate more force to pump blood against the higher pressure within the arteries, leading to hypertrophy as the muscle fibers increase in size. This thickening may initially benefit the heart by allowing it to augment its pumping ability, but it can eventually lead to a reduced volume of the chamber and complications such as heart failure. Continued pressure overload can also impair the heart's ability to relax, resulting in diastolic dysfunction, which manifests as symptoms of heart failure.

While hypertension is indeed associated with other cardiovascular complications, such as coronary artery disease and arrhythmias, the direct effect concerning the heart's structure and function over time is best exemplified by the development of left ventricular hypertrophy. Right ventricular dilation is less common and typically occurs in the context of other conditions, such as pulmonary hypertension or chronic lung disease.