High-Sensitivity Cardiac Troponin T and Risk of Hypertension

Abstract

Background Hypertension is often preceded by cardiac structural abnormalities. Thus, we assessed whether high-sensitivity cardiac troponin-T (hs-cTNT), a marker of chronic subclinical myocardial damage, can identify persons at risk for hypertension or left ventricular hypertrophy (LVH). Methods and Results We studied 6,516 ARIC Study participants, 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 BP >140/90 mmHg over 6 years). Relative to hs-cTNT <5ng/L, adjusted hazard ratios for incident diagnosed hypertension were 1.16 (95% CI 1.08, 1.25) for persons with hs-cTNT 5–8ng/L, 1.29 (1.14, 1.47) for hs-cTNT 9–13ng/L, and 1.31 (1.07, 1.61) for hs-cTNT ≥14ng/L (p-trend <0.001). Associations were stronger for incident visit-based hypertension. These associations were driven by higher relative hazard in normotensive persons (compared to those with prehypertension, p-interaction=0.001). Baseline hs-cTNT was also strongly associated with incident LVH by electrocardiography over 6 years (e.g. adjusted HR 5.19 [1.49–18.08] for hs-cTNT ≥14ng/L vs <5ng/L). Findings were not appreciably changed after accounting for competing deaths or adjustment for baseline BP levels or NT-proBNP. Conclusions In an ambulatory population with no history of cardiovascular disease, hs-cTNT was associated with incident hypertension and risk of LVH. Further research is needed to determine whether hs-cTNT can identify persons who may benefit from ambulatory BP monitoring or hypertension prevention lifestyle strategies.

Relation of Coronary Artery Calcium and Extra-Coronary Aortic Calcium to Incident Hypertension (from the Multi-Ethnic Study of Atherosclerosis)

“…CAC may also identify subjects with abnormal BP (either below the threshold for hypertension diagnosis or who have as yet to receive a diagnosis) complicated by endothelial dysfunction, aortic stiffness, 18,19 and/or left ventricular hypertrophy, 20–23 all of which are associated with hypertension risk. Furthermore, CAC may reflect the cumulative exposure of the vasculature to BP, including abnormal diurnal BP patterns, and masked hypertension, all of which increase susceptibility to development of hypertension but are not well-captured using office-based BP measurements.…”

25‐Hydroxyvitamin D Levels and Markers of Subclinical Myocardial Damage and Wall Stress: The Atherosclerosis Risk in Communities Study

“…Elevated hs‐cTnT was defined as a level ≥14 ng/L, and elevated NT‐proBNP was defined as a level ≥100 pg/mL, consistent with prior studies. Baseline characteristics of the study participants were described using means with their standard deviations or proportions stratified by 25(OH)D groups.…”

Blood Pressure and Fibrinogen Responses to Mental Stress as Predictors of Incident Hypertension over an 8-Year Period

“…We defined hypertension as elevated BP in a clinical session, physician diagnosis, and/or the use of antihypertensive medication. Such a definition may lead to some misclassification, but this method has been used extensively in the Whitehall II where it produces valid results [41, 42], and similar criteria are employed in other epidemiological studies such as the Atherosclerosis Risk in Communities and Framingham Heart Studies [43, 44]. We did not obtain measures of dietary sodium and potassium that are potentially relevant.…”