Pre-clinical Cardiac Dysfunction Among Asymptomatic Hypertensive Patients
Status:
Completed
Trial end date:
2011-06-01
Target enrollment:
Participant gender:
Summary
This project will evaluate the clinical and cost effectiveness of a novel, multidisciplinary
approach to identify and treat pre-clinical cardiac dysfunction (PCCD) in asymptomatic
hypertensive patients identified in a single center urban emergency department. Premature
onset of pressure-related cardiac complications of hypertension (especially heart failure)
has important implications for long-term survival, quality of life and healthcare costs. This
project will target patients who have already developed pressure-related cardiac structural
abnormalities yet remain symptom free. These individuals are at tremendous risk for
progression to clinically overt heart failure and its associated consequences. We hypothesize
that detection and treatment of patients with hypertension who have pre-clinical structural
cardiac damage will enable forestallment of the disease process and offer the opportunity to
reduce the burden of cardiac morbidity associated with hypertension. This project will
implement a program to prospectively identify PCCD (using echocardiography) and provide
treatment. At present, the optimal blood pressure goal for patients with PCCD is unknown so
this study will randomize patients to 2 levels of blood pressure control: "normal", which is
consistent with current national guidelines and "intensive", which will aim for a markedly
lower blood pressure (< 120/80). Enrolled patients will receive active treatment and
follow-up for 1 year. At the end of 1 year, we will evaluate: 1) the ability of this program
to achieve blood pressure goals; 2) the cost effectiveness; and 3) the proportion in each
blood pressure group who have evidence of disease regression on echocardiography.