Why does high blood pressure cause a heart attack?

Atherosclerosis: Hypertension is a major cause of atherosclerosis which may cause heart attacks.

May not: Many people with high BP do not have heart attacks. The heart is strained and hypertrophied, and in the presence of atherosclerosis may have obstruction and dissection, or plaque disruption to create a heart attack.

Not the main: Hypertension causes left ventricular hypertrophy and strain and heart failure. Concomitant coronary disease can occur and infarction can happen hypertension is also asso. With aortic tear-dissection and that can involve coronaries and cause infarction. More to the entire story but that' s a start.