Modeling the Impact of Biomarker-Guided Versus ASCVD Risk-Guided Drug Treatment in US Adults With Stage 1 Hypertension: The National Health and Nutrition Examination Survey, 1999 to 2004.

Publisher: Lippincott, Williams & Wilkins Country of Publication: United States NLM ID: 7906255 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4563 (Electronic) Linking ISSN: 0194911X NLM ISO Abbreviation: Hypertension Subsets: MEDLINE

Publication: : Hagerstown, MD : Lippincott, Williams & Wilkins
Original Publication: [Dallas, Tex.] : [American Heart Association], [©1979]-

Hypertension*/drug therapy ; Hypertension*/epidemiology ; Hypertension*/blood ; Biomarkers*/blood ; Nutrition Surveys* ; Antihypertensive Agents*/therapeutic use ; Peptide Fragments*/blood; Humans ; Male ; Female ; Middle Aged ; United States/epidemiology ; Adult ; Aged ; Risk Assessment/methods ; Natriuretic Peptide, Brain/blood ; Atherosclerosis/epidemiology ; Atherosclerosis/blood ; Atherosclerosis/drug therapy ; Troponin T/blood ; Troponin I/blood

Background: Guidelines recommend antihypertensive medication for adults with both stage 1 hypertension (systolic blood pressure, 130-139 mm Hg or diastolic blood pressure, 80-89 mm Hg) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk ≥10%. Cardiac biomarkers could facilitate a more targeted approach to the treatment of stage 1 hypertension.
Methods: We studied 1999 to 2004 National Health and Nutrition Examination Survey participants aged ≥20 years with untreated stage 1 hypertension without heart failure or ASCVD. We measured hs-cTnI (high-sensitivity cardiac troponin I), hs-cTnT (high-sensitivity cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) in stored serum. We used the Pooled Cohort Equations to predict 10-year ASCVD risk. All participants had linked mortality follow-up through December 31, 2019.
Results: Overall, 17.5% of US adults (32.2 million) had untreated stage 1 hypertension. Among these 32.2 million persons, 15.7% had ASCVD risk ≥10%, 5.6% had elevated hs-cTnI, 4.7% had elevated hs-cTnT, and 9.5% had elevated NT-proBNP. Among adults aged 65 to 79 years with untreated stage 1 hypertension, 80.5% had ASCVD risk ≥10%, 13.0% had elevated hs-cTnI, 15.2% had elevated hs-cTnT, and 29.4% had elevated NT-proBNP. Less than half of the adults aged ≥80 years with untreated stage 1 hypertension had elevated biomarkers. The cardiovascular disease mortality rates among all adults with untreated stage 1 hypertension and with either ASCVD risk ≥10%, elevated hs-cTnI, elevated hs-cTnT, or elevated NT-proBNP were 7.51, 7.74, 8.75, and 5.87 per 1000 person-years, respectively.
Conclusions: Cardiac biomarkers may be more selective for informing risk-based treatment decisions in stage 1 hypertension, particularly among adults aged ≥65 years.
Competing Interests: Disclosures R. Christenson has received grant support from Roche Diagnostics, Fujirebio Diagnostics, Beckman Coulter, Siemens Healthcare Diagnostics, Ortho Clinical Diagnostics, Becton Dickinson, Abbott Diagnostics, Mitsubishi, and Horiba Medical; and has consulting agreements with PixCell, Beckman Coulter, Quidel, Siemens Healthineers, and Roche Diagnostics. E. Selvin receives payments from Wolters Kluwer for chapters and laboratory monographs in UpToDate on measurements of glycemic control and screening tests for type 2 diabetes. The other authors report no conflicts.

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K23 HL135273 United States HL NHLBI NIH HHS; K24 HL152440 United States HL NHLBI NIH HHS; T32 HL007024 United States HL NHLBI NIH HHS

Keywords: biomarkers; blood pressure; cardiovascular diseases; hypertension; troponin

0 (Biomarkers)
0 (Antihypertensive Agents)
0 (Peptide Fragments)
0 (pro-brain natriuretic peptide (1-76))
114471-18-0 (Natriuretic Peptide, Brain)
0 (Troponin T)
0 (Troponin I)

Date Created: 20240501 Date Completed: 20240612 Latest Revision: 20240614

20240614

PMC11168872

10.1161/HYPERTENSIONAHA.123.22665

38690651