Should African–Americans with elevated blood pressure be routinely screened for hypertensive heart disease?

Levy, Phillip D.; Flack, John M.

doi:10.1586/erc.12.130

Cited by 6 publications

(4 citation statements)

References 20 publications

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“…In conclusion, our data support the findings from previous studies that emphasize the need for intensive screening for early stages of hypertension-related cardiac damage to prevent symptomatic HHD in the elderly, where most cases occur [23][24][25][26][27][28], and suggest a need for national initiatives that will slow the progression of HHD in patients with hypertension and reduce the related risk of disability and premature death.…”

Section: Discussionsupporting

confidence: 89%

Epidemiology of hypertensive heart disease in Poland: findings from the Global Burden of Disease Study 2016

et al. 2021

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IntroductionHypertension may cause target organ damage leading to hypertensive heart disease (HHD). The burden caused by HHD in Poland has not been studied systematically. The purpose of this study was to describe the burden of HHD in Poland in terms of prevalence, mortality, disabilityadjusted life years lost (DALY) and key risk factors.Material and methodsData were obtained from the Global Burden of Diseases, Injuries and Risk Factors (GBD) Study database. The GBD uses a wide range of data sources and complex statistical methods to estimate disease burden for all countries by age, sex, and year. HHD was defined by ICD-9 codes 402-402.91 and ICD-10 codes I11-I11.9. From the GBD 2016 estimates, we extracted data for Poland between 1990 and 2016.ResultsHypertensive heart disease is the fourth most important cause of cardio- and cerebrovascular death, after ischemic heart disease, stroke and cardiomyopathy. In 2016, there were about 180 000 people diagnosed with HHD in Poland and close to 5000 HHD-related deaths. HHD prevalence increased from 0.29% in 1990 to 0.47% in 2016 and was higher in women, while mortality increased from 11.2 to 12.7 per 100 000, largely due to population aging. Age-standardized death and DALY rates declined between 1990 and 2016 and were lower than in Central Europe but higher than in Western Europe.ConclusionsOur data suggest a need for national initiatives to improve the diagnosis and treatment of hypertension, slow the progression of HHD, and reduce the related risks and premature deaths.

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Section: Discussionsupporting

confidence: 89%

Epidemiology of hypertensive heart disease in Poland: findings from the Global Burden of Disease Study 2016

et al. 2021

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“…Although some perceive that screening of asymptomatic patients provides no long‐term benefit to morbidity, compelling arguments have been made for the utility of screening activities in communities that are predominately urban, African American and where limitations to healthcare access prompts heavy reliance on the emergency department (ED) for primary care . Increasing prevalence of the target condition is often tied to cost‐effectiveness of such approaches and, in the case of SHHD, has direct implications for intensification of antihypertensive therapy …”

mentioning

confidence: 99%

“…11,[32][33][34][35] Increasing prevalence of the target condition is often tied to cost-effectiveness of such approaches and, in the case of SHHD, has direct implications for intensification of antihypertensive therapy. 36 The development of preventable secondary complications of SHHD leads to substantial increases in morbidity, mortality, and health care costs. 37 Multiple studies have demonstrated that uncontrolled HTN is a significant risk factor for the progression of SHHD and the onset of chronic HF and other clinically overt conditions.…”

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confidence: 99%

Screening and Treatment for Subclinical Hypertensive Heart Disease in Emergency Department Patients With Uncontrolled Blood Pressure: A Cost‐effectiveness Analysis

Twiner

Marinica

Kuper

et al. 2017

Academic Emergency Medicine

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Objectives Poorly controlled hypertension (HTN) is extremely prevalent and, if left unchecked, subclinical hypertensive heart disease (SHHD) may ensue leading to conditions such as heart failure. To address this, we designed a multidisciplinary program to detect and treat SHHD in a high-risk, predominantly African American community. The primary objective of this study was to determine the cost-effectiveness of our program. Methods Study costs associated with identifying and treating patients with SHHD were calculated and a sensitivity analysis was performed comparing the effect of four parameters on cost estimates. These included prevalence of disease, effectiveness of treatment (regression of SHHD, reversal of left ventricular hypertrophy [LVH], or blood pressure [BP] control as separate measures), echocardiogram costs, and participant time/travel costs. The parent study for this analysis was a single-center, randomized controlled trial comparing cardiac effects of standard and intense (<120/80 mm Hg) BP goals at 1 year in patients with uncontrolled HTN and SHHD. A total of 149 patients (94% African American) were enrolled, 133 (89%) had SHHD, 123 (93%) of whom were randomized, with 88 (72%) completing the study. Patients were clinically evaluated and medically managed over the course of 1 year with repeated echocardiograms. Costs of these interventions were analyzed and, following standard practices, a cost per quality-adjusted life-year (QALY) less than $50,000 was defined as cost-effective. Results Total costs estimates for the program ranged from $117,044 to $119,319. Cost per QALY was dependent on SHHD prevalence and the measure of effectiveness but not input costs. Cost-effectiveness (cost per QALY less than $50,000) was achieved when SHHD prevalence exceeded 11.1% for regression of SHHD, 4.7% for reversal of LVH, and 2.9% for achievement of BP control. Conclusions In this cohort of predominantly African American patients with uncontrolled HTN, SHHD prevalence was high and screening with treatment was cost-effective across a range of assumptions. These data suggest that multidisciplinary programs such as this can be a cost-effective mechanism to mitigate the cardiovascular consequences of HTN in emergency department patients with uncontrolled BP.

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“…This is consistent with previous studies that validated the Framingham CVD risk algorithm in African American populations 21,22 . However, to our knowledge this is the first time that the Framingham CVD risk score has been applied to a population at such high risk for hypertensive end organ damage 23 and our findings may guide future efforts aimed at risk stratification of ED patients with severely elevated BP 24 .…”

Section: Discussionmentioning

confidence: 79%

Utility of Framingham Risk Score in Urban Emergency Department Patients with Asymptomatic Hypertension

Brody

Flack

Ference

et al. 2014

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Hypertension (HTN) is the primary population-attributable risk for the development of heart failure (HF); a disease with devastating consequences particularly in urban centers where morbidity and mortality are more pronounced. The Framingham Risk Profile (FRP) is widely used to quantify risk for cardiovascular disease (CVD), but its applicability in an urban population who utilize the emergency department (ED) for primary care is unknown. Our objective for this study is to evaluate FRP scores in ED patients with asymptomatic HTN and subclinical hypertensive heart disease (SHHD). This is a sub study of a prospective randomized clinical trial designed to evaluate optimal blood pressure (BP) targets. Eligible patients were screened with echocardiography for the presence of SHHD and FRP scores were calculated. 149 patients enrolled in the study, 133 (89.2%) of whom had detectable SHHD. Mean [SD] calculated FRP scores were statistically similar for patients with SHHD vs. those without (general CVD: 20.2 [8.5] vs. 15.6 [8.7]; p=0.13 and HF calibrated: 2.4 [1.0] vs. 1.8 [1.0]; p=0.12) corresponding to a calculated risk of 15%–30% for subsequent development of CVD. The HF specific risk score for patients with SHHD was 2.4, which equates to a 2.5% risk of HF development in 10 years. The FRP correctly identified those with SHHD as high-risk for general CVD but appeared to underestimate the likelihood of HF. Recalibration of the HF adjustment factor and inclusion of additional data elements such as echocardiography is needed to enhance applicability of the FRP in this setting.

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Should African–Americans with elevated blood pressure be routinely screened for hypertensive heart disease?

Cited by 6 publications

References 20 publications

Epidemiology of hypertensive heart disease in Poland: findings from the Global Burden of Disease Study 2016

Epidemiology of hypertensive heart disease in Poland: findings from the Global Burden of Disease Study 2016

Screening and Treatment for Subclinical Hypertensive Heart Disease in Emergency Department Patients With Uncontrolled Blood Pressure: A Cost‐effectiveness Analysis

Utility of Framingham Risk Score in Urban Emergency Department Patients with Asymptomatic Hypertension

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