BackgroundNearly half of patients who visit the emergency department (ED) in the United States have asymptomatic hypertension (HTN), and this disproportionately affects Blacks. Subclinical heart disease (SHD) (systolic and/or diastolic dysfunction) is ubiquitous, affecting more than 90% of ED patients in some studies, leading to conditions such as congestive heart failure (CHF). Identifying a biomarker/point-of-care test that may serve as a surrogate for detecting SHD may improve vigilance with follow up to primary care from the ED for treatment, and the development of secondary complications from having SHD.Study Objectives. Brain natriuretic peptide (BNP) levels well below contemporary thresholds used for the diagnosis of CHF are associated with adverse cardiovascular outcomes in community patients with asymptomatic HTN. The objective of this study is to determine the diagnostic accuracy of BNP for predicting echocardiographic evidence of SHD in emergency patients with asymptomatic uncontrolled HTN.Study Design/MethodsThis is a multi-center prospective observational proof of concept study. A series of sample calculations determined a convenience sample of N=76 is necessary to achieve our objective. Adults (≥ 18 years old) who have asymptomatic (ie no chest pain) HTN (BP ≥ 160/100 mmHg and 2nd ≥ 140/90 mmHg) are being recruited from two urban EDs in New York City. Patients with a history of CHF, renal insufficiency, and cardiovascular comorbidity, are excluded. BNP levels are categorized into high and low BNP levels, according to values above and below the 80th percentile (BNP 20 pg/ml for men and BNP 23.3 pg/ml for women). EKG evidence of left ventricular hypertrophy (LVH) by Cornell Voltage Criterion and evidence of SHD are collected. Preliminary results are described.Results/FindingsA total of 32 patients have been recruited from one ED-site thus far. Roughly half are male (n=15; 47%) or female (n=17, 53%). A majority(93%) self-identified as Non-White (Black, Hispanic, Asian, Other) (n=30). Additional analyses will be performed on demographics upon study completion. Two patients were missing an ultrasound , leaving 30 participants for analysis. Eighty-seven percent (n=26) have evidence of SHD, a majority having left ventricular hypertrophy (n=20; 77%), and fifty-seven percent (n=15) also had an abnormal BNP level. Very few (n=3, 9.6%) had EKG evidence of left ventricular hypertrophy. We did not perform bivariate analyses due to the small sample size.ConclusionThe majority of emergency patients who have asymptomatic HTN have an elevated BNP and/or echocardiographic evidence of SHD, which is consistent with the literature to date. A receiver operator curve will be calculated to predict echocardiographic evidence of SHD upon study completion. Future work may include comparison of other biomarkers to determine the most sensitive marker for detecting SHD.No, authors do not have interests to disclose BackgroundNearly half of patients who visit the emergency department (ED) in the United States have asymptomatic hypertension (HTN), and this disproportionately affects Blacks. Subclinical heart disease (SHD) (systolic and/or diastolic dysfunction) is ubiquitous, affecting more than 90% of ED patients in some studies, leading to conditions such as congestive heart failure (CHF). Identifying a biomarker/point-of-care test that may serve as a surrogate for detecting SHD may improve vigilance with follow up to primary care from the ED for treatment, and the development of secondary complications from having SHD.Study Objectives. Brain natriuretic peptide (BNP) levels well below contemporary thresholds used for the diagnosis of CHF are associated with adverse cardiovascular outcomes in community patients with asymptomatic HTN. The objective of this study is to determine the diagnostic accuracy of BNP for predicting echocardiographic evidence of SHD in emergency patients with asymptomatic uncontrolled HTN. Nearly half of patients who visit the emergency department (ED) in the United States have asymptomatic hypertension (HTN), and this disproportionately affects Blacks. Subclinical heart disease (SHD) (systolic and/or diastolic dysfunction) is ubiquitous, affecting more than 90% of ED patients in some studies, leading to conditions such as congestive heart failure (CHF). Identifying a biomarker/point-of-care test that may serve as a surrogate for detecting SHD may improve vigilance with follow up to primary care from the ED for treatment, and the development of secondary complications from having SHD. Study Objectives. Brain natriuretic peptide (BNP) levels well below contemporary thresholds used for the diagnosis of CHF are associated with adverse cardiovascular outcomes in community patients with asymptomatic HTN. The objective of this study is to determine the diagnostic accuracy of BNP for predicting echocardiographic evidence of SHD in emergency patients with asymptomatic uncontrolled HTN. Study Design/MethodsThis is a multi-center prospective observational proof of concept study. A series of sample calculations determined a convenience sample of N=76 is necessary to achieve our objective. Adults (≥ 18 years old) who have asymptomatic (ie no chest pain) HTN (BP ≥ 160/100 mmHg and 2nd ≥ 140/90 mmHg) are being recruited from two urban EDs in New York City. Patients with a history of CHF, renal insufficiency, and cardiovascular comorbidity, are excluded. BNP levels are categorized into high and low BNP levels, according to values above and below the 80th percentile (BNP 20 pg/ml for men and BNP 23.3 pg/ml for women). EKG evidence of left ventricular hypertrophy (LVH) by Cornell Voltage Criterion and evidence of SHD are collected. Preliminary results are described. This is a multi-center prospective observational proof of concept study. A series of sample calculations determined a convenience sample of N=76 is necessary to achieve our objective. Adults (≥ 18 years old) who have asymptomatic (ie no chest pain) HTN (BP ≥ 160/100 mmHg and 2nd ≥ 140/90 mmHg) are being recruited from two urban EDs in New York City. Patients with a history of CHF, renal insufficiency, and cardiovascular comorbidity, are excluded. BNP levels are categorized into high and low BNP levels, according to values above and below the 80th percentile (BNP 20 pg/ml for men and BNP 23.3 pg/ml for women). EKG evidence of left ventricular hypertrophy (LVH) by Cornell Voltage Criterion and evidence of SHD are collected. Preliminary results are described. Results/FindingsA total of 32 patients have been recruited from one ED-site thus far. Roughly half are male (n=15; 47%) or female (n=17, 53%). A majority(93%) self-identified as Non-White (Black, Hispanic, Asian, Other) (n=30). Additional analyses will be performed on demographics upon study completion. Two patients were missing an ultrasound , leaving 30 participants for analysis. Eighty-seven percent (n=26) have evidence of SHD, a majority having left ventricular hypertrophy (n=20; 77%), and fifty-seven percent (n=15) also had an abnormal BNP level. Very few (n=3, 9.6%) had EKG evidence of left ventricular hypertrophy. We did not perform bivariate analyses due to the small sample size. A total of 32 patients have been recruited from one ED-site thus far. Roughly half are male (n=15; 47%) or female (n=17, 53%). A majority(93%) self-identified as Non-White (Black, Hispanic, Asian, Other) (n=30). Additional analyses will be performed on demographics upon study completion. Two patients were missing an ultrasound , leaving 30 participants for analysis. Eighty-seven percent (n=26) have evidence of SHD, a majority having left ventricular hypertrophy (n=20; 77%), and fifty-seven percent (n=15) also had an abnormal BNP level. Very few (n=3, 9.6%) had EKG evidence of left ventricular hypertrophy. We did not perform bivariate analyses due to the small sample size. ConclusionThe majority of emergency patients who have asymptomatic HTN have an elevated BNP and/or echocardiographic evidence of SHD, which is consistent with the literature to date. A receiver operator curve will be calculated to predict echocardiographic evidence of SHD upon study completion. Future work may include comparison of other biomarkers to determine the most sensitive marker for detecting SHD.No, authors do not have interests to disclose The majority of emergency patients who have asymptomatic HTN have an elevated BNP and/or echocardiographic evidence of SHD, which is consistent with the literature to date. A receiver operator curve will be calculated to predict echocardiographic evidence of SHD upon study completion. Future work may include comparison of other biomarkers to determine the most sensitive marker for detecting SHD.