What type of study is this?

This is a Systematic Review study (also classified as: Literature Review).

August 22, 2025Open Access

Evaluating the Prognostic Significance of Circulating Biomarkers of End Organ Damage in Hypertension

EMElliot MbetaUniversity of Liverpool CWCathy WilliamsUniversity Hospitals Bristol NHS Foundation Trust JYJames R. YatesUniversity of Liverpool

Key Points

Elevated cardiac biomarkers BNP/NT-proBNP and troponin I significantly increase the risk of MACE in hypertensive patients, indicating their prognostic value.
Review of 17 studies encompassing 70,021 participants provided a strong association between cardiac biomarkers and adverse outcomes, emphasizing the need for validation.
Systematic review methodology was employed, using PRISMA guidelines to synthesize data from various studies in the assessment of biomarker utility.
Findings suggest that while biomarkers are promising for risk assessment, further large-scale studies are essential to establish their clinical applicability.

Abstract

Background: Most patients with hypertension exhibit elevated and detectable levels of natriuretic peptides, particularly BNP and NT-proBNP, as well as troponin concentrations. However, the prognostic relevance of this finding has not been clearly established in patients who have hypertension without heart failure (HF). In this review, we aimed to evaluate the prognostic utility of BNP/NT-proBNP alongside troponin T/I for risk stratification in hypertensive patients, excluding those with HF. Methods: This systematic review was registered in PROSPERO (CRD42024552031). A systematic literature search was conducted using two online databases, Ovid Medline and Web of Science, to identify studies. Data retrieved from articles were used in line with the PRISMA statement guidelines. Participants were aged ≥ 18 years with hypertension. The primary end point was a major adverse cardiac event (MACE) and its individual components. Descriptive synthesis was performed, and data are presented in tabular form. Results: Seventeen studies (70,021 participants) were retrieved for analysis comprising eight prospective cohort studies, six randomized controlled trials, and three retrospective studies. The review evaluated cardiac biomarkers: BNP (n = 6), NT proBNP (n=9), troponin T (n = 4), and troponin I (n = 7). Studies predicted composite MACE (n = 8), all-cause mortality (n = 7), HF (n = 6), and atrial fibrillation (n = 3) outcomes. Cardiac biomarkers showed a strong association with reported outcomes. However, heterogeneity in biomarker thresholds and methodologies limited comparability. Conclusions: The obtained results suggest that elevated cardiac biomarkers BNP/NT-proBNP and troponin I are associated with significantly higher risk of MACE and are powerful predictors in clinical setting. However, large-scale studies are required to validate the robustness and prognostic utility of these biomarkers

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