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Untreated hypertension can lead to several severe health complications, with the development of heart failure being one of the most significant. Hypertension causes the heart to work harder to pump blood against the increased pressure in the arteries. Over time, this added strain can lead to the thickening of the heart muscle (left ventricular hypertrophy), which diminishes the heart's ability to pump effectively.

As the heart's efficiency declines, it can eventually lead to heart failure, a condition where the heart cannot pump sufficiently to maintain blood flow to meet the body's needs. Heart failure can present with symptoms such as shortness of breath, fatigue, and fluid retention, significantly impacting the quality of life and requiring extensive medical management.

In contrast, the other options do not directly relate to the consequences of untreated hypertension. For example, developing asthma is not linked to hypertension, and improvement of cardiac efficiency is counterintuitive given the strain caused by high blood pressure. Also, untreated hypertension increases the risk of stroke rather than decreasing it, as elevated blood pressure can lead to damage and dysfunction in blood vessels, heightening the likelihood of stroke.