Troponin and B-type Natriuretic Peptides Biomarkers in the Management of Hypertension

Abstract

studies have shown a continuous association between elevated blood pressure (BP) and incident coronary heart disease (CHD), stroke, heart failure (HF), and vascular mortality, with the association noted from BPs above 115/75 mmHg. [4] Meta-analyses of randomized controlled trial (RCTs) including several hundred thousand patients have shown that a 10-mmHg reduction in systolic BP (SBP) or a 5-mmHg reduction in diastolic BP (DBP) is associated with significant reductions of ~ 20% for all major CV events, 10–15% for all-cause mortality, ~ 35% for stroke, ~ 20% for coronary events, and ~ 40% for HF. [3,5] In guidelines recommend BP thresholds to simplify the diagnosis of and guide treatment decisions in the management of hypertension. The American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for the Prevention, and Management of High BP [6] recommend cardiovascular risk assessment in the management of and advocate for intensive for with >130/80 given have shown for The (SPRINT) showed individuals Abstract The American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for the management of high blood pressure (BP) recommend intensive BP goals in high-risk individuals. However, intensive BP therapy comes with a higher risk of side effects. It is, therefore, important to identify individuals with higher cardiovascular risk who will in turn derive the greatest absolute benefit from BP reduction. In line with this, both ACC/AHA and European guidelines on the management of hypertension recommend the use of risk assessment using traditional risk factors. The European guidelines also recommend complementing risk estimation using additional markers of hypertension-mediated organ damage. Cardiac biomarkers such as natriuretic peptide and high sensitivity cardiac troponins (hs-cTn) reflect structural and/or functional changes in end organs (i.e., myocardium, vasculature) and have been associated with increased cardiovascular risk. These cardiac biomarkers may supplement risk assessment of patients with elevated BP and help personalize treatment strategies. Both NT-pro B type Natriuretic Peptide (NT-proBNP) and hs-cTn have been shown to predict cardiovascular events across different systolic and diastolic BP categories. Furthermore, observational data suggest that individuals with elevated levels of NT-proBNP and/or high-sensitivity troponin have lower numbers needed to treat to prevent cardiovascular events with intensive BP therapy, with the lowest NNT seen in those with elevated levels of both. While the data related to biomarkers in hypertension are encouraging, future randomized clinical trials are needed to further characterize the clinical utility of biomarker-based evaluation and treatment strategies in patients with hypertension.