Role of Natriuretic Peptides and Cardiac Troponins in Staging Hypertensive Heart Disease: the REMODEL study

Aims To evaluate whether circulating N-terminal pro-B type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hsTnT) can stage hypertensive heart disease (HHD), by assessing their association with adverse cardiac remodelling and cardiovascular outcomes in individuals with essential hypertension. Methods and Results The REMODEL study prospectively enrolled 1,054 asymptomatic individuals with essential hypertension and no prior cardiovascular diseases (59±11 years old; systolic blood pressure 131±14 mmHg; left ventricular ejection fraction 60±7%). All participants underwent cardiovascular magnetic resonance (CMR) and blood sampling for NT-proBNP and hsTnT. The primary outcome was a composite of acute coronary syndromes, heart failure hospitalization, stroke and all-cause mortality. Median follow-up was 53 [23, 72] months. Maximal log-rank statistic identified thresholds of 152 pg/mL for NT-proBNP and 12.7 pg/mL for hsTnT. Individuals with elevations in both biomarkers (high-risk) were older, had the highest 24-hour systolic blood pressure and more diabetes mellitus. They showed the most adverse CMR phenotype, with increased myocardial mass, greater diffuse and replacement fibrosis, impaired left ventricular strain and higher left atrial volumes. Event rates differed significantly across biomarker strata (log-rank P <0.001). High-risk individuals had the greatest hazard of cardiovascular events (HR 17.11; 95%CI 8.12–36.09), while intermediate-risk individuals showed intermediate risk (HR 3.44; 95%CI 1.71–6.94). Conclusions NT-proBNP and hsTnT are complementary biomarkers that not only predict cardiovascular outcomes and but also reflect the severity of cardiac remodelling in HHD. Their combined use enables effective staging of disease severity and may support stage-specific management strategies in patients with hypertension.