Effect of Intensive Blood Pressure Control on Troponin and Natriuretic Peptide Levels: Findings From SPRINT
Jarett D Berry1,2, Haiying Chen3, Vijay Nambi4
1Department of Internal Medicine, University of Texas at Tyler School of Medicine (J.D.B.).
Circulation
|December 19, 2022
Summary
Intensive blood pressure lowering increased cardiac troponin T (hs-cTnT) due to reduced kidney function but decreased NT-proBNP, explained by lower blood pressure. These findings question hs-cTnT
Area of Science:
- Cardiology
- Nephrology
- Hypertension Research
Background:
- Hypertension contributes to heart failure via cardiac injury and neurohormonal activation.
- High-sensitivity cardiac troponin T (hs-cTnT) and NT-proBNP levels correlate with hypertension sequelae.
- Hypothesized that intensive systolic blood pressure (SBP) lowering reduces hs-cTnT and NT-proBNP.
Purpose of the Study:
- To investigate the impact of intensive SBP lowering on hs-cTnT and NT-proBNP levels.
- To determine the mediating factors for changes in these cardiac biomarkers.
- To assess the association between biomarker changes and risks of heart failure and death.
Main Methods:
- Utilized stored specimens from the SPRINT trial for hs-cTnT and NT-proBNP measurements at baseline and 1 year.
- Employed linear and multinomial logistic regression to analyze continuous and categorical biomarker changes.
- Applied multivariable-adjusted Cox proportional hazards models to assess associations with heart failure and death.
Main Results:
- Intensive SBP lowering increased hs-cTnT by 3% (geometric mean ratio 1.03) and the proportion of participants with a ≥50% increase (OR 1.47).
- Intensive SBP lowering decreased NT-proBNP by 10% (geometric mean ratio 0.90) and the probability of a ≥50% increase (OR 0.57).
- hs-cTnT changes were linked to kidney function (eGFR), while NT-proBNP changes were linked to SBP reduction; both biomarkers predicted heart failure and death risk.
Conclusions:
- Intensive SBP lowering elevates hs-cTnT, mediated by reduced kidney filtration.
- Intensive SBP lowering decreases NT-proBNP, attributed to SBP reduction.
- Findings emphasize noncardiac factors in cardiac biomarker variability and question hs-cTnT's role as a surrogate marker in SBP-lowering studies.
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