Cardiac Troponin-T and N-Terminal Pro-B-Type Natriuretic Peptide Related to Other Clinical High-Risk Factors in Patients on at Least Two Antihypertensive Agents

Objective: Cardiac biomarkers are useful in identifying patients with high risk of cardiovascular events. We aimed to identify how cardiac troponin T (cTnT) and N-Terminal Pro-B-Type Natriuretic Peptide (NT-pro-BNP) relate to other clinical high-risk markers in patients with treated essential hypertension in a national multicenter study. Design and method: We performed a cross-sectional study of patients with hypertension treated with > =2 antihypertensive agents. Cardiovascular risk factors were identified by interview, blood and urine tests, and physical examination. Ambulatory (ABPM) and office BP were measured with validated devices. High-sensitive cTnT and NT-pro-BNP were measured from stored serum samples at a core laboratory using Elecsys Troponin T Gen 5 STAT and Elecsys pro-BNP II (Roche Diagnostics, Basel, Switzerland). Continuous variables are presented as median (interquartile ranges [IQR]) and categorical variables as percentages. Multivariable logistic regression models were used to test for associations between risk factors and elevated cTnT > =14 ng/L or elevated NT-pro-BNP > =125 ng/L. Results: In 550 patients (36.5% women) aged 64 years (IQR 57-72) with daytime ABPM of 143/84 mmHg, 199 patients (36.2%) had high cTnT > =14 ng/L and 138 (25.1%) patients had high NT-pro-BNP > =125 ng/L. Elevated cTnT was independently associated with higher HbA1c (p=0.045) and history of diabetes (p<0.001) when adjusting for age, sex, estimated GFR and pulse pressure. Elevated NT-pro-BNP was independently associated with higher pulse pressure (p=0.008), number of antihypertensive agents (p<0.001), aldosterone/renin ratio (p<0.001), lower HDL (p=0.02), use of antithrombotic (p=0.002) and lipid-modifying (p=0.02) drugs and a history of coronary heart disease (p=0.02) when adjusting for age, sex and estimated GFR. Conclusions: We found that elevated cTnT and NT-pro-BNP were independently associated with several clinical markers of increased risk for cardiovascular events in patients with hypertension treated with > =2 antihypertensive drugs, when adjusting for age, sex and estimated GFR. Prospective studies should further explore the potential of these cardiac biomarkers to individualize risk assessment in patients with uncontrolled hypertension.