Clinical Heart and Vascular Center
Elizabeth Barrett-Connor Award Session: Biomarkers of Hypertension and HF Risk
At the AHA Scientific Sessions, I presented findings from our study at the Elizabeth Barrett-Connor Award Session, and I’m extremely grateful for having been named the recipient of that esteemed award. As background for our study, the 2017 AHA/ACC guidelines for blood pressure control emphasize use of a cardiovascular risk-driven approach to guide treatment of high blood pressure in the moderately elevated range (120-140) and recommend using the 10-year atherosclerotic cardiovascular disease risk to identify individuals who might benefit from anti-hypertensive therapies. However, the greatest benefit of intensive blood pressure control lies in the reduction of HF risk, which may be underestimated by the atherosclerotic cardiovascular disease risk assessment calculator. In contrast, biomarkers of cardiac injury and stress, such as high-sensitivity troponin and NT-ProBNP, are strong predictors of heart failure risk. The utility of these biomarkers in identifying individuals with moderately elevated blood pressure who might benefit from intensive blood pressure control in the context of the current guideline-recommended cardiovascular risk-based approach is not well established.
“We observed that, among individuals with moderately elevated blood pressure who are not currently recommended for antihypertensive therapies, elevated hs-cTnT or NT-proBNP identifies individuals who are at higher risk for cardiovascular events and might benefit from initiation of antihypertensive medication.”
In our study, we pooled data from three large cohorts with available data on circulating levels of high-sensitivity troponin and NT-ProBNP at baseline and incident cardiovascular events (heart failure and atherothrombotic events). We observed that, among individuals with moderately elevated blood pressure who are not currently recommended for antihypertensive therapies, elevated hs-cTnT or NT-proBNP identifies individuals who are at higher risk for cardiovascular events and might benefit from initiation of antihypertensive medication. In contrast, among individuals with nonelevated biomarkers, the cardiovascular risk is comparable to those with normal blood pressure and thus might not need intensive blood pressure control. Taken together, incorporation of biomarkers into risk assessment algorithms for BP treatment could further stratify cardiovascular risk and lead to more appropriate matching of intensive BP control with patient risk. Concurrent with this AHA presentation, our study was published in Circulation (2019, vol. 140, doi: 10.1161/circulationaha.119.043337).