More Aggressive Blood Pressure Control Could Reduce HF, Mortality Risk

By Jarett Berry, M.D.

Professor of Internal Medicine

Myocardial injury, as measured by highly sensitive cardiac troponin (hscTn), and neurohormonal stress, as measured by N-terminal pro BNP (NTproBNP), are well-known blood-based biomarkers that are strongly associated with both heart failure and mortality risk. However, it is unknown whether this risk is modifiable. Based on prior research from observational data, we hypothesized that more aggressive blood pressure control could reduce this risk.

At the recent AHA Scientific Sessions meeting, we presented data from the SPRINT trial, a large, randomized, controlled trial in patients with hypertension and at increased risk for cardiovascular disease, which compared the impact of intensive blood pressure control (to < 120 mm Hg) with standard of care (to < 140 mm Hg) on cardiovascular risk. In this trial, we measured both hscTn and NTproBNP at the time of randomization. We sought to compare the impact of intensive blood pressure control among patients in the trial with elevated vs. normal biomarker levels.

In our study, we observed marked differences in the treatment benefit among individuals with vs. without elevated biomarkers, with dramatically greater absolute risk reductions among those with elevated biomarkers. Specifically, we found that among patients with elevated biomarkers, only 14 patients would need to be treated with intensive blood pressure control to save one life. In contrast, among patients with normal biomarkers, more than 100 patients would need to be treated to save one life.

These data suggest that simple, easily available blood tests could be used to identify which patients would benefit the most from intensive blood pressure treatment. We believe these data could have implications for how we prioritize patient selection for intensive blood pressure lowering and therefore have public health implications.