Evidence of Subclinical Heart Disease in an Asymptomatic Hypertensive Urban ED Population

The objective of this study was to prospectively determine the point prevalence of subclinical heart disease (diastolic dysfunction and left ventricular hypertrophy) in a minority ED population with a significant cardiovascular risk burden. The study design and setting involved a prospective cross sectional analysis conducted at the University of Illinois Hospital & Health Sciences System Emergency Department. A total of 47 patients were enrolled. The mean age was 44 years (SD 11.5 years), 58 % (n=27) were women, 21% (n=10) were smokers, 81% had hypertension (n=39), and 26% (n=10) required blood pressure treatment in the ED. The average BMI was 30.59 (SD=8.53). Racial/ethnicity included African Americans 70% (n=33), Latinos 22% (n=10), Caucasian 4% (n=2), Asian and Native Americans 2% (n=1 respectively). Subclinical hypertensive disease was found in 45 % (n=21) with 43% (n=12) having left ventricular hypertrophy, 14% (n=6) having evidence of diastolic dysfunction and 7% (n=3) having abnormal ejection fraction. After adjusting for other covariates, systolic BP (p= 0.04), creatinine (p=0.02), and being on the Angiotensin Converting Enzymes Inhibitors (ACEI) (p=0.06) were associated with subclinical heart disease in multivariate regression analysis. This study found a significant point prevalence of subclinical heart disease in patients with asymptomatic hypertension evaluated in an urban ED setting. This is particularly important in the prevention of hypertension-related cardiovascular complications such as heart failure. Studies have shown that left ventricular (LV) remodeling and the development of left ventricular hypertrophy (LVH) precedes the development of subclinical LV dysfunction (i.e. diastolic dysfunction) and aggressive treatment of hypertension can greatly attenuate the initial development of LVH.