2
|
Jespersen MM, Munk Jensen SS, Harbak J, Jeppesen KF, Revsholm J, Nybo M. Can High-Sensitivity Troponins Predict Future Hypertension? A Systematic Literature Review. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:613-618. [PMID: 31651192 DOI: 10.1080/00365513.2019.1683765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Hypertension (HT) is associated with cardiovascular events and increased mortality, and identification of persons at risk in due time is therefore important. Finding a biomarker to identify those at risk will enable early preventive treatment, and high-sensitivity cardiac troponin (hs-cTn) seems to be a highly relevant candidate. To gather the existing knowledge on the association between hs-cTn and future HT, a systematic literature review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) reporting guidelines and using the PICOS system. Medline was searched until August 2018. Of 45 extracted papers, eleven papers were eligible for the study. None were randomized controlled trials. Three studies assessed hs-cTnI, eight studies assessed hs-cTnT. All studies found statistically significant associations between hs-cTn concentrations and future HT, but the studies included different types of blood pressure (diastolic, systolic, diurnal). Due to differences in troponin assay construction and test capability, a direct comparison of test performance in terms of specificity, sensitivity and predictive values was not possible, and a specific hs-cTn cutoff value for HT prediction could therefore not be defined. Furthermore, a number of conditions known to affect troponin concentrations (e.g. gender, renal function, and co-morbidities) were not sufficiently studied. All retrieved studies found significant associations between hs-cTn concentrations and future HT; although the findings are promising, the studies were too heterogeneous, and many conditions affecting troponin concentrations needs investigation at these low concentrations before hs-cTn can be considered a useful HT predictor.
Collapse
Affiliation(s)
- Mette M Jespersen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Simon S Munk Jensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jonathan Harbak
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Kristian F Jeppesen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jesper Revsholm
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Mads Nybo
- Clinical Diagnostics Department, Hospital of Southwest Jutland, Odense University Hospital, Odense, Denmark
| |
Collapse
|
3
|
Tehrani DM, Fan W, Nambi V, Gardin J, Hirsch CH, Amsterdam E, deFilippi CR, Polonsky T, Wong ND. Trends in Blood Pressure and High-Sensitivity Cardiac Troponin-T With Cardiovascular Disease: The Cardiovascular Health Study. Am J Hypertens 2019; 32:1013-1020. [PMID: 31232455 PMCID: PMC6758940 DOI: 10.1093/ajh/hpz102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/16/2019] [Accepted: 06/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) is individually associated with incident hypertension (HTN) and cardiovascular disease (CVD) events. We hypothesize that the increases in hs-cTnT with increases in blood pressure will be related to higher incidence of CVD. METHODS The Cardiovascular Health Study is a longitudinal cohort of older adults. Those with hs-cTnT data and CVD risk factors at baseline and follow-up (2-3 years later) were stratified based on systolic blood pressure (SBP; optimal: <120 mm Hg, intermediate: 120-139 mm Hg, elevated: ≥140 mm Hg) and hs-cTnT (undetectable: <5 ng/l, detectable: 5-13 ng/l, elevated: ≥14 ng/l) categories. SBP and hs-cTnT were classified as increased or decreased if they changed categories between exams, and stable if they did not. Cox regression evaluated incident CVD events over an average 9-year follow-up. RESULTS Among 2,219 adults, 510 (23.0 %) had decreased hs-cTnT, 1,279 (57.6 %) had stable hs-cTnT, and 430 (19.4 %) had increased hs-cTnT. Those with increased hs-cTnT had a higher CVD risk with stable SBP (hazard ratio [HR]: 1.28 [1.04-1.57], P = 0.02) or decreased SBP (HR: 1.57 [1.08-2.28], P = 0.02) compared to those within the same SBP group but a stable hs-cTnT. In those with lower SBP at follow-up, there was an inverse relation between diastolic blood pressure (DBP) and risk of CVD events in those with increased hs-cTnT (HR: 0.44 per 10 mm Hg increase, P < 0.01). CONCLUSION An increase in hs-cTnT over time is associated with a higher risk of CVD even when the blood pressure is stable or decreases over time.
Collapse
Affiliation(s)
- David M Tehrani
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Wenjun Fan
- Health Policy Research Institute, University of California Los Angeles, Los Angeles, California, USA
| | - Vijay Nambi
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Julius Gardin
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Calvin H Hirsch
- Department of Medicine, University of California Davis, Sacramento, California, USA
| | - Ezra Amsterdam
- Department of Medicine, University of California Davis, Sacramento, California, USA
| | | | - Tamar Polonsky
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, Medical Sciences, University of California Irvine, Irvine, California, USA
| |
Collapse
|
8
|
Jagodzinski A, Neumann JT, Ojeda F, Sörensen NA, Wild P, Münzel T, Zeller T, Westermann D, Blankenberg S. Cardiovascular Biomarkers in Hypertensive Patients with Medical Treatment-Results from the Randomized TEAMSTA Protect I Trial. Clin Chem 2017; 63:1877-1885. [PMID: 28904053 DOI: 10.1373/clinchem.2017.275289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND High blood pressure (BP) is associated with an increased rate of cardiovascular events and mortality. Cardiovascular biomarkers are able to predict long-term risk in the general population, particularly in diseased cohorts. We undertook an investigation of the effect of 2 different antihypertensive treatments on cardiovascular biomarkers in a randomized trial. METHODS The TEAMSTA study included 481 hypertensive patients. They were randomized to either 80-mg telmisartan + 5-mg amlodipine (TA) or 40-mg olmesartan + 12.5-mg hydrochlorothiazide (OH). The trial was performed as a prospective, randomized, double-blinded, controlled, single-center study. We measured BP, high-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity cardiac troponin T (hs-cTnT), B-type natriuretic peptide (BNP), and N-terminal-pro-BNP (NT-proBNP) before randomization and after 6 months. RESULTS Individuals were randomized into 2 groups: 230 individuals to the OH-group and 251 to the TA-group. After 6 months of treatment, a reduction in BP (systolic/diastolic) was seen, from 135.2/85.2 mmHg to 122.5/75.7 mmHg with similar effects in both groups. hs-cTnT concentrations were measureable in 26.2% of the study population, while hs-cTnI was detected in 98.3%. hs-cTnI concentrations were significantly reduced from 4.6 to 4.2 ng/L in the overall population, from 4.7 to 4.4 ng/L in the OH-group, and from 4.6 to 4.0 ng/L in the TA-group (all P < 0.001). No significant changes of hs-cTnT were observed. BNP and NT-proBNP concentrations decreased from 15.0 to 12.4 ng/L (P < 0.001) and from 64.8 to 53.3 ng/L (P < 0.001), respectively, after 6 months. CONCLUSIONS The reduction in BP was associated with a decrease of high-sensitivity troponin I, BNP, and NT-proBNP concentrations, which might represent a cardiovascular risk reduction. CLINICAL TRIAL REGISTRATION EudraCT 2009-017010-68.
Collapse
Affiliation(s)
- Annika Jagodzinski
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Johannes Tobias Neumann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; .,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Nils Arne Sörensen
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Philipp Wild
- Department of Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany.,German Center for Cardiovascular Research, Partner Site RheinMain, Mainz, Germany.,Center for Translational Vascular Biology, University Medical Center Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research, Partner Site RheinMain, Mainz, Germany.,Center for Translational Vascular Biology, University Medical Center Mainz, Germany.,Center for Cardiology-Cardiology I, University Medical Center Mainz, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| |
Collapse
|
10
|
McEvoy JW, Chen Y, Nambi V, Ballantyne CM, Sharrett AR, Appel LJ, Post WS, Blumenthal RS, Matsushita K, Selvin E. High-Sensitivity Cardiac Troponin T and Risk of Hypertension. Circulation 2015; 132:825-33. [PMID: 26152706 DOI: 10.1161/circulationaha.114.014364] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 06/25/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The diagnosis of hypertension is often preceded by cardiac structural abnormalities. Thus, we assessed whether high-sensitivity cardiac troponin T (hs-cTnT), a marker of subclinical myocardial damage, can identify individuals at risk for hypertension or left ventricular hypertrophy. METHODS AND RESULTS We studied 6516 Atherosclerosis Risk in Communities (ARIC) Study participants who were free of prevalent hypertension and cardiovascular disease at baseline (1990-1992). We examined the association of baseline hs-cTnT categories with incident diagnosed hypertension (defined by self-report of a diagnosis or medication use during a maximum of 19.9 years of follow-up) and with incident visit-based hypertension (defined by self-report, medication use, or measured blood pressure >140/90 mm Hg over 6 years). Relative to hs-cTnT <5 ng/L, adjusted hazard ratios for incident diagnosed hypertension were 1.16 (95% confidence interval, 1.08-1.25) for individuals with hs-cTnT of 5 to 8 ng/L, 1.29 (95% confidence interval, 1.14-1.47) for hs-cTnT of 9 to 13 ng/L, and 1.31 (95% confidence interval, 1.07-1.61) for hs-cTnT ≥14 ng/L (P for trend <0.001). Associations were stronger for incident visit-based hypertension. These associations were driven by higher relative hazard in normotensive people (compared with those with prehypertension; P for interaction=0.001). Baseline hs-cTnT was also strongly associated with incident left ventricular hypertrophy by electrocardiography over 6 years (eg, adjusted hazard ratio, 5.19 [95% confidence interval, 1.49-18.08] for hs-cTnT ≥14 versus <5 ng/L). Findings were not appreciably changed after accounting for competing deaths or adjusting for baseline blood pressure levels or N-terminal probrain natriuretic peptide. CONCLUSIONS In an ambulatory population with no history of cardiovascular disease, hs-cTnT was associated with incident hypertension and risk of left ventricular hypertrophy. Further research is needed to determine whether hs-cTnT can identify people who may benefit from ambulatory blood pressure monitoring or hypertension prevention lifestyle strategies.
Collapse
Affiliation(s)
- John W McEvoy
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Yuan Chen
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Vijay Nambi
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Christie M Ballantyne
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - A Richey Sharrett
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Lawrence J Appel
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Wendy S Post
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Roger S Blumenthal
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Kunihiro Matsushita
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.)
| | - Elizabeth Selvin
- From Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M., Y.C., A.R.S., L.J.A., W.S.P., K.M., E.S.); Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (J.W.M., W.S.P., R.S.B.); Michael E. DeBakey Veterans Affairs Hospital, Houston, TX (V.M.); and Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine and Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (V.M., C.M.B.).
| |
Collapse
|