title: Correlation between Subclinical Heart Disease and Cardiovascular Risk Profiles in an Urban Emergency Department Population with Elevated Blood Pressures: A Pilot Study.
abstract: 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.
authors: Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
authors: Heather M
authors: HM
authors: Prendergast
authors: Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
authors: Joseph
authors: J
authors: Colla
authors: Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
authors: Neal
authors: N
authors: Patel
authors: Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
authors: Marina
authors: M
authors: Del Rios
authors: Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
authors: Jared
authors: J
authors: Marcucci
authors: Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
authors: Ryan
authors: R
authors: Scholz
authors: Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
authors: Patience
authors: P
authors: Ngwang
authors: Department of Emergency Medicine, University of Illinois, Chicago, Illinois.
authors: Katherine
authors: K
authors: Cappitelli
authors: Institute of Minority Health Research, University of Illinois, Chicago, Illinois.
authors: Martha
authors: M
authors: Daviglus
authors: Section of Cardiology, Brown University, Providence, Rhode Island.
authors: Samuel
authors: S
authors: Dudley
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D058070:Asymptomatic Diseases / Q000453:epidemiology; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D003971:Diastole; D004636:Emergency Service, Hospital; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology*; D006786:Hospitals, Urban; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D012307:Risk Factors; D013318:Stroke Volume; D014505:Urban Population; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents
keywords: elevated blood pressure; emergency department; emergency provider echocardiogram; subclinical heart disease