High-sensitivity troponin T predicts worsening of albuminuria in hypertension; results of a nested case–control study with confirmation in diabetes

Hellemons, Merel E.; Heerspink, Hiddo J L; Gansevoort, Ron T.; Zeeuw, Dick de; Bakker, Stephan J. L.

doi:10.1097/hjh.0b013e32835eb5e8

Cited by 20 publications

(13 citation statements)

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“…However, the relationship between hsTnT and renal outcomes remained strong ( p < 0.001) even after adjusting for baseline eGFR. hsTnT is a marker of myocardial injury and micronecrosis, it is therefore possible that cardiac vascular disease, reflected by slightly raised hsTnT levels, could be paralleled by vascular disease in other organs, including the kidneys [33]. …”

Section: Discussionmentioning

confidence: 99%

Cardiovascular disease biomarkers are associated with declining renal function in type 2 diabetes

et al. 2017

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Aims/hypothesisWe investigated whether biochemical cardiovascular risk factors and/or markers of subclinical cardiovascular disease were associated with the development of reduced renal function in people with type 2 diabetes.MethodsA cohort of 1066 Scottish men and women aged 60–74 years with type 2 diabetes from the Edinburgh Type 2 Diabetes Study were followed up for a median of 6.7 years. New-onset reduced renal function was defined as two eGFRs <60 ml−1 min−1 (1.73 m)−2 at least 3 months apart with a > 25% decline from baseline eGFR. Ankle brachial pressure index (ABI), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT) were measured at baseline. Pulse wave velocity (PWV) and carotid intima media thickness were measured 1 year into follow-up. Data were analysed using Cox proportional hazards models.ResultsA total of 119 participants developed reduced renal function during follow-up. ABI, PWV, NT-proBNP and hsTnT were all associated with onset of decline in renal function following adjustment for age and sex. These associations were attenuated after adjustment for additional diabetes renal disease risk factors (systolic BP, baseline eGFR, albumin:creatinine ratio and smoking pack-years), with the exception of hsTnT which remained independently associated (HR 1.51 [95% CI 1.22, 1.87]). Inclusion of hsTnT in a predictive model improved the continuous net reclassification index by 0.165 (0.008, 0.286).Conclusions/interpretationOur findings demonstrate an association between hsTnT, a marker of subclinical cardiac ischaemia, and subsequent renal function decline. Further research is required to establish the predictive value of hsTnT and response to intervention.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular disease biomarkers are associated with declining renal function in type 2 diabetes

et al. 2017

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“…Indeed, prior case-control data suggest that hs-cTNT is also associated with subsequent albuminuria in hypertensive patients. 39 It is also worth noting that hs-cTNT could potentially be contributing more directly to the development of hypertension. For example, elevated hs-cTNT has been linked with arterial stiffness in diabetics 40 .…”

Section: Discussionmentioning

confidence: 99%

High-Sensitivity Cardiac Troponin T and Risk of Hypertension

et al. 2015

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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.

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“…A novel hs‐cTnT assay allows for the identification of previously undetected early stages of myocardial injury. It has been shown that hs‐cTnT levels within the normal range increase in hypertensive patients . The exact mechanisms underlying increased hs‐cTnT levels in hypertensive patients without ischemic heart disease are unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Even within the normal range, circulating high‐sensitivity cardiac troponin‐T (hs‐cTnT) strongly correlates with cardiac structure abnormalities such as LV hypertrophy and LV dysfunction in the general population and in hypertensive patients . hs‐ cT nT predicts worsening of albuminuria in HTN …”

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High‐Sensitivity Cardiac Troponin T Predicts Nondipper Hypertension in Newly Diagnosed Hypertensive Patients

Çaylı

Gür

Elbasan

et al. 2013

J of Clinical Hypertension

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The increased prognostic accuracy of the high-sensitivity cardiac troponin T (hs-cTnT) assay vs the conventional cTnT assay has recently been reported in hypertensive patients. The authors aimed to investigate the significance of serum hs-cTnT marker for prediction of nondipper hypertension (HTN) in hypertensive patients. A total of 317 patients with newly diagnosed HTN were studied. The patients were divided into two groups: 198 dipper hypertensive patients (mean age, 51.7AE5.1 years) and 119 nondipper hypertensive patients (mean age, 53.4AE7.6 years). Hs-cTnT and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in all patients. hs-cTnT and NT-proBNP were independent predictors for nondipper HTN (P<.05 for all). The cutoff value of hs-cTnT obtained by the receiver operator curve analysis was 7.55 ng/L for the prediction of nondipper HTN (sensitivity: 79%, specificity: 70%; 95% confidence interval, 0.769-0.860; P<.001). In patients with HTN, higher serum concentration of hs-cTnT even within normal range is an independent predictor of nondipper HTN. J Clin Hypertens (Greenwich). 2013;15:731-736. ª2013 Wiley Periodicals, Inc.Hypertension (HTN) is one of the major risk factors for cardiovascular diseases. Blood pressure (BP) is characterized with alteration of rhythm during 24 hours in hypertensive patients.1 It has been shown that 24-hour ambulatory BP monitoring (ABPM) is a better predictor of subsequent complications than spot measurements of BP.2 The most recent guidelines recommend ABPM as the primary diagnostic tool for HTN. 3Mean BP values are 10% to 20% lower at night, compared with daytime measurements. This condition is called ''dipper'' change. However, in some hypertensive patients, contrary to this normal change, nighttime BP lowering does not occur or shows a decrease <10%, which is called ''nondipper'' change. 4 It is known that endothelial dysfunction, 5 target organ damage such as left ventricular (LV) hypertrophy, 6 arterial stiffness, 7 autonomic dysfunction, 8 oxidative status, and DNA damage 9 are more severe in nondipper hypertension (NDH) than in dipper hypertension (DH). In addition, NDH itself is a risk factor for mortality. 10Most patients with HTN even without myocardial necrosis have cardiac troponin T concentrations that are undetectable with conventional assays.11 Even within the normal range, circulating high-sensitivity cardiac troponin-T (hs-cTnT) strongly correlates with cardiac structure abnormalities such as LV hypertrophy and LV dysfunction in the general population and in hypertensive patients.11,12 hs-cTnT predicts worsening of albuminuria in HTN. 13In patients presenting with essential HTN, the serum concentrations of hs-cTnT are slightly or moderately higher than in normotensive patients.11 However, as far as we know, there have been no studies performed until today on the association of hs-cTnT with dipper and NDH. We aimed to investigate the significance of serum hs-cTnT marker for prediction of NDH in newly diagnosed hypertensive patients. METHODSA total...

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High-sensitivity troponin T predicts worsening of albuminuria in hypertension; results of a nested case–control study with confirmation in diabetes

Abstract: We identified hs-TnT as an independent marker predicting the transition in albuminuria stage in hypertension beyond conventional risk-markers. These findings were confirmed in patients with T2DM.

Cited by 20 publications

References 32 publications

Cardiovascular disease biomarkers are associated with declining renal function in type 2 diabetes

Cardiovascular disease biomarkers are associated with declining renal function in type 2 diabetes

High-Sensitivity Cardiac Troponin T and Risk of Hypertension

High‐Sensitivity Cardiac Troponin T Predicts Nondipper Hypertension in Newly Diagnosed Hypertensive Patients

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