Subclinical Hypertensive Heart Disease in Black Patients With Elevated Blood Pressure in an Inner-City Emergency Department

Abstract

We examine the point prevalence of subclinical hypertensive heart disease in a cohort of urban emergency department (ED) patients with elevated blood pressure. A convenience sample of hypertensive (blood pressure ≥ 140/90 mm Hg on 2 measurements) patients aged 35 years or older with no history of cardiac or renal disease who presented to a single urban ED and were asymptomatic from a cardiovascular perspective (ie, no symptoms of dyspnea or chest pain) were enrolled. All patients underwent a standardized evaluation (including echocardiography), and subclinical hypertensive heart disease was defined by the presence of one or more of the following criterion-based echocardiographic [corrected] findings: left-ventricular hypertrophy, systolic dysfunction, or diastolic dysfunction. A total of 161 patients were included. Mean age was 49.8 years (SD 8.3 years), 93.8% were black, and 51.6% were men. Nearly all (93.8%) had a history of hypertension, and many (68.3%) were receiving antihypertensive therapy at baseline. Mean systolic and diastolic blood pressures were 183.9 mm Hg (SD 25.1 mm Hg) and 109.5 mm Hg (SD 14.4 mm Hg), respectively. Subclinical hypertensive heart disease was found in 146 patients (90.7%; 95% confidence interval [CI] 85.2% to 94.3%), with most (n=131) displaying evidence of diastolic dysfunction (89.7%; 95% CI 83.7% to 93.7%). Left-ventricular hypertrophy was also common (n=89; 61.0%; 95% CI 52.9% to 68.5%) and was often (but not exclusively) present in those with diastolic filling abnormalities (n=75; 57.3%; 95% CI 48.7% to 65.4%). In our largely black cohort of ED patients with elevated blood pressure, subclinical hypertensive heart disease was highly prevalent, suggesting the need for coordinated efforts to reduce cardiac consequences of hypertension in such inner-city communities.