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Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department
Heather M Prendergast1, Joseph Colla1, Neal Patel1
1Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
Insights
Uncontrolled hypertension significantly increases cardiovascular risks. This study found 39% of emergency department patients with elevated blood pressure had subclinical heart disease, indicating a need for early detection and intervention.
Area of Science:
- Cardiology
- Emergency Medicine
- Hypertension Research
Background:
- Uncontrolled hypertension is a major risk factor for cardiovascular complications.
- Early identification of subclinical heart disease is crucial for managing hypertensive patients.
Purpose of the Study:
- To determine the prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in an urban emergency department (ED) population with elevated blood pressure (BP).
- To explore correlations between subclinical heart disease and patient cardiovascular risk profiles.
Main Methods:
- A convenience sample of patients with elevated BP (>140/90 mmHg) underwent limited bedside echocardiograms (LBE).
- Subclinical hypertensive heart disease was defined by the presence of LVH, abnormal ejection fraction (EF), or diastolic dysfunction.
Main Results:
- 39% of enrolled patients (n=39) exhibited subclinical heart disease.
- Prevalence included 31% with LVH, 15% with diastolic dysfunction, and 8% with abnormal EF.
- Elevated BP, blood urea nitrogen, and ED antihypertensive medication administration were associated with subclinical heart disease.
Conclusions:
- A significant point prevalence (39%) of subclinical heart disease was identified in this urban ED population using LBE.
- Real-time identification of subclinical heart disease and abnormal renal function in the ED can guide aggressive therapy and urgent follow-up.
Background:
Uncontrolled hypertension is a primary risk factor for development of cardiovascular complications.
Objective:
Determine the point prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in an urban emergency department (ED) population with elevated blood pressures (BP) and examine correlations between subclinical disease and patient cardiovascular risk profiles.
Methods:
A convenience sample of patients with EBP (>140/90 on two measurements) had limited bedside echocardiograms (LBE). Subclinical hypertensive heart disease was classified as the presence of: LVH, abnormal ejection fraction (EF), or diastolic dysfunction.
Results:
Thirty-nine patients with EBP were enrolled. The mean age was 46 years (SD = 10.9), 59% were women, 21% were smokers, and 92% had a history of hypertension. The average body mass index was 30.7 (SD = 8.7). Patients were 67% African American, 23% Latino, 5% Caucasian, 3% Asian, and 3% Native American. Subclinical disease was found in 39%: 31% had LVH, 15% had diastolic dysfunction, and 8% had abnormal EF. On bivariate analysis, elevated BP (p = 0.039) and blood urea nitrogen (p = 0.016) were correlated with subclinical heart disease. After adjusting for other covariates, receiving oral/intravenous antihypertensive medications in the ED (p = 0.005) was associated with subclinical heart disease.
Conclusions:
We found a point prevalence of subclinical heart disease of 39% in this urban ED population, using LBE. Real-time identification of subclinical heart disease at early stages in the ED in conjunction with abnormal renal function can help emergency physicians identify those patients in need of more aggressive therapy and urgent follow-up.
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