B‐Type Natriuretic Peptide as a Marker of Subclinical Heart Disease in a High‐Burden Emergency Department Population With Sustained Asymptomatic Hypertension

B-Type natriuretic peptide (BNP) levels below contemporary thresholds for diagnosing congestive heart failure are associated with subclinical heart disease (SHD) and adverse cardiovascular outcomes in community patients with uncontrolled asymptomatic hypertension. This study aimed to determine the accuracy of BNP for detecting SHD in emergency patients with sustained asymptomatic hypertension, where SHD is universally prevalent. Conducted at two urban academic emergency departments within a seven-hospital healthcare organization, this proof-of-concept study included adults with sustained asymptomatic hypertension (initial BP ≥ 160/100 mmHg and second BP ≥ 140/90 mmHg), excluding those with congestive heart failure, renal insufficiency, atrial fibrillation, pregnancy, incarceration, cognitive impairment, and symptomatic hypertension. Enrolled patients underwent bedside echocardiograms, BNP lab tests, and electrocardiograms. All 78 patients (100%) had SHD. The cohort was predominantly female (55.1%), middle-aged (mean age: 52 ± 15.2 years), with Class I obesity (mean BMI: 32.3 ± 8.3) and a high prevalence of hypertension history (55.1%). Common findings included left ventricular hypertrophy (86%), diastolic dysfunction (70.5%), and left ventricular systolic dysfunction (12.2%). The BNP lab test accurately detected SHD in nearly 60% of patients, with a Type II error rate of approximately 40%. In this proof-of-concept study, BNP underperformed in a cohort with universally present SHD, suggesting that sole reliance on BNP may lead to missed opportunities for early intervention.