Patient presents with complaints consistent with hypertensive heart failure.  Symptoms include dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and lower extremity edema.  The patient reports a history of long-standing hypertension, poorly controlled despite medication adherence issues.  Physical exam reveals elevated blood pressure, jugular venous distension, S3 heart sound, and bibasilar crackles on lung auscultation.  Electrocardiogram shows left ventricular hypertrophy.  Echocardiogram demonstrates reduced ejection fraction confirming left ventricular systolic dysfunction.  Diagnosis of hypertensive heart failure with reduced ejection fraction established based on clinical presentation, history of hypertension, and diagnostic testing results.  Treatment plan includes optimization of heart failure medications such as ACE inhibitors, beta-blockers, and diuretics, along with reinforcement of the importance of hypertension management.  Patient education provided regarding lifestyle modifications including sodium restriction, fluid management, and regular exercise.  Follow-up scheduled to monitor treatment response and adjust medications as needed.  Differential diagnoses considered included valvular heart disease and other causes of cardiomyopathy, but ruled out based on echocardiogram findings.  ICD-10 code I11.0 for hypertensive heart disease with heart failure assigned.  Medical billing codes will reflect evaluation and management services, echocardiogram, and electrocardiogram.  Prognosis discussed with the patient, emphasizing the importance of adherence to the treatment plan for optimal outcome.