Intensive BP control can modify risk associated with elevated troponin T and natriuretic peptide levels: JAMA
USA: A recent study has noted that the risk of heart failure and death in people with elevated hs-cTnT and NT-proBNP levels can be modified with intensive systolic blood pressure control. The study findings are published in the journal JAMA Cardiology.
Elevated levels of N-terminal pro–B-type natriuretic peptide (NTproBNP) and high-sensitivity cardiac troponin T (hscTnT) are associated with risk of heart failure (HF) and mortality among individuals in the general population. However, if this risk is modifiable is not known. To address this, Jarett D. Berry, University of Texas Southwestern Medical School, Dallas, and colleagues test the hypothesis that elevated hscTnT and NTproBNP levels would identify individuals with the greatest risk for mortality and HF and the largest benefit associated with intensive systolic blood pressure (SBP) lowering.
The researchers conducted a post hoc analysis of the prospective, randomized Systolic Blood Pressure Intervention Trial (SPRINT) trial. The study included a total of 9361 patients without diabetes with an increased risk for cardiovascular disease. They were randomized to receive intensive (<120 mm Hg) or standard (<140 mm Hg) SBP lowering. The levels of high-sensitivity cardiac troponin T and NTproBNP were measured from stored specimens collected at enrollment. Elevated levels were defined as 14 ng/L or more for hscTnT and 125 pg/mL or more for NTproBNP.
The primary outcome of this ancillary study was HF and mortality.
Of the 9361 participants enrolled in SPRINT, 8828 (5578 men [63.2%]; mean age, 68.0 years) had measured hscTnT levels and 8836 (5585 men [63.2%]; mean age, 68.0 years) had measured NTproBNP levels; 2262 of 8828 patients (25.6%) had elevated hscTnT levels, 3371 of 8836 patients (38.2%) had elevated NTproBNP, and 1411 of 8828 patients (16.0%) had both levels elevated.
The study found the following:
- Randomization to the intensive SBP group led to a 4.9% absolute risk reduction (ARR) over 4 years in death and HF (421 events) for those with elevated hscTnT and a 1.7% ARR for those without elevated levels.
- Similarly, for those with elevated NTproBNP, the ARR for death and HF over 4 years was 4.6% vs 1.8% in those without elevated levels.
- For those with elevated levels of both biomarkers, the ARR for death and HF over 4 years was 7.8% vs 1.7% in those with neither biomarker elevated.
- No significant treatment group by biomarker category interactions were detected.
Berry and colleagues concluded, "intensive SBP control led to large absolute differences in death and HF among patients with abnormal hscTnT and NTproBNP levels. These findings demonstrate that risk associated with elevation of these biomarkers is modifiable with intensive BP control."
The researchers add that there is a need for a prospective, randomized clinical trial to evaluate whether these biomarkers may help guide the selection of patients for intensive SBP lowering.
Reference:
Berry JD, Nambi V, Ambrosius WT, et al. Associations of High-Sensitivity Troponin and Natriuretic Peptide Levels With Outcomes After Intensive Blood Pressure Lowering: Findings From the SPRINT Randomized Clinical Trial. JAMA Cardiol. Published online September 01, 2021. doi:10.1001/jamacardio.2021.3187
