TY - JOUR
T1 - Incorporation of Biomarkers into Risk Assessment for Allocation of Antihypertensive Medication According to the 2017 ACC/AHA High Blood Pressure Guideline
T2 - A Pooled Cohort Analysis
AU - Pandey, Ambarish
AU - Patel, Kershaw V.
AU - Vongpatanasin, Wanpen
AU - Ayers, Colby
AU - Berry, Jarett D.
AU - Mentz, Robert J.
AU - Blaha, Michael J.
AU - McEvoy, John W.
AU - Muntner, Paul
AU - Vaduganathan, Muthiah
AU - Correa, Adolfo
AU - Butler, Javed
AU - Shimbo, Daichi
AU - Nambi, Vijay
AU - Defilippi, Christopher
AU - Seliger, Stephen L.
AU - Ballantyne, Christie M.
AU - Selvin, Elizabeth
AU - De Lemos, James A.
AU - Joshi, Parag H.
N1 - Funding Information:
This study was supported by the Texas Health Resources Clinical Scholarship to Dr Pandey. The ARIC study is conducted as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN2 68201100006C, HHSN268201100007C, HHSN268201100008C, HHSN26820 1100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201 100012C). The Dallas Heart Study was funded by a grant from the Donald W. Reynolds Foundation. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001105 to the University of Texas Southwestern Medical Center. The Jackson Heart Study is supported and conducted in collaboration with Jackson State University (HH-SN268201800013I), Tougaloo College (HHSN268201800014I), the Mississippi State Department of Health (HHSN268201800015I), and the University of Mississippi Medical Center (HHSN268201800010I, HHSN268201800011I and HHSN268201800012I) contracts from the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. A full list of participating Multi-Ethnic Study of Atherosclerosis investigators and institutions can be found at http://www.mesa-nhlbi.org. The Multi-Ethnic Study of Atherosclerosis was supported by R01 HL071739 and contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, and N01HC 95169 from the National Heart, Lung, and Blood Institute. Reagents for the NT-proBNP and high-sensitivity cardiac troponin T assays were donated by Roche Diagnostics.
Funding Information:
Mr. Ayers has received statistical consulting fees from the NIH. Dr Ballantyne has grant/research support (all significant; all paid to institution, not individual) from Ak-cea, Amarin, Amgen, Esperion, Novartis, Regeneron, Sanofi-Synthelabo, National Institutes of Health, American Heart Association, and American Diabetes Association and is a consultant for Akcea, Amarin, Amgen, AstraZeneca (significant), Eli Lilly, Esperion, Matinas BioPharma Inc, Merck (significant), Novartis, Regeneron, and Sanofi-Synthelabo (significant). In addition, Dr Ballantyne had patent 61721475 (“Biomarkers to Improve Prediction of Heart Failure Risk”) filed by Baylor College of Medicine and Roche pending. Dr Berry reports grants from the National Institutes of Health (1RO1HL144112-01), Abbott, and Roche (nonfinancial support for biomarker-related research activities) and serves as a National Coordinator for the STRENGTH trial (Statin Residual Risk Reduction with Epanova in High Cardiovascular Risk Patients with Hypertriglyceridemia) sponsored by AstraZeneca. Dr Blaha is supported by US National Institutes of Health/National Heart, Lung, and Blood Institute grant L30 HL110027. Dr Butler has received research support from the National Institutes of Health, Patient-Centered Outcomes Research Institute, and the European Union; and serves as a consultant for Amgen, Array, AstraZeneca, Bayer, Boehringer In-gelheim, Bristol Myers Squib, CVRx, G3 Pharmaceutical, Innolife, Janssen, Luitpold, Medtronic, Merck, Novartis, Relypsa, StealthPeptide, SC Pharma, Vifor, and ZS Pharma. Dr deFilippi reported grants from Roche Diagnostics, Abbott Diagnostics, FujiRe-bio, and Siemens Healthcare Diagnostics and personal fees from Alere, Radiometer, Ortho Diagnostics, UpToDate, WebMD, Siemens Healthcare, Roche Diagnostics, and Metabolomics. In addition, Dr deFilippi had a patent to US20170234888 issued.
Funding Information:
Drs deFilippi and de Lemos had a patent to US20170234888 issued. Dr de Lemos reported grants from Abbott Diagnostics and Roche Diagnostics; personal fees from Abbott Diagnostics, Roche Diagnostics, Ortho Clinical Diagnostics, Quidel, Siemens Health Care Diagnostics and Radiometer. Dr Joshi reported grants from the American Heart Association, Novo Nordisk, AstraZeneca, GSK, Sanofi, Regeneron, and Pfizer; and personal fees from Bayer and Regeneron. Dr McEvoy is the recipient of an American Heart Association award (17MCPRP33400031) and is supported by both the P.J. Schafer Cardiovascular Research Fund and the Johns Hopkins Magic That Matters Research Fund for Cardiovascular Research. Dr Mentz reported grants and personal fees from Novartis, Amgen, and Astra-Zeneca; receives research support from the National Institutes of Health (grant-sU01HL125511-01A1, U10HL110312, and R01AG045551-01A1), Akros, Am-gen, AstraZeneca, Bayer, GlaxoSmithKline, Gilead, Luitpold, Medtronic, Merck, Novartis, Otsuka, and ResMed; receives honoraria from Abbott, Amgen, Astra-Zeneca, Bayer, Janssen, Luitpold Pharmaceuticals, Medtronic, Merck, Novartis, and ResMed; and has served on an advisory board for Amgen, Luitpold, Merck, and Boehringer Ingelheim. Dr Muntner has received research support and honoraria from Amgen and research grant from National Heart, Lung, and Brain Institute (RO1 HL117323). Dr Nambi serves as the site principal investigator on a study sponsored by Merck, holds a provisional patent on biomarkers for the prediction of heart failure along with Baylor College of Medicine and Roche, and is an event adjudicator on a study sponsored by Siemens. Dr Pandey is supported by the Texas Health Resources Clinical Scholarship. Dr Patel is supported by NHLBI T32 postdoctoral training grant (5T32HL125247-03). Dr Seliger reported grants from Roche Diagnostics and personal fees from Abbvie Inc. In addition, Dr Seliger had a patent to “Methods for Assessing Differential Risk of Developing Heart” issued (US20170234888). Dr Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (NIH/NCATS Award UL 1TR002541), serves on advisory boards for Amgen, AstraZeneca, Bayer AG, and participates in clinical end points committees for studies supported by Novartis and the National Institutes of Health. Dr Vongpatanasin is supported by NIH/NHLBI grants R01HL133179, R01AG057571, and NIH/NIDDK grant P30DK079328. Dr Selvin was supported by NIH/NIDDK grants K24DK106414 and R01DK089174.
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/12/17
Y1 - 2019/12/17
N2 - Background: Risk for atherosclerotic cardiovascular disease was a novel consideration for antihypertensive medication initiation in the 2017 American College of Cardiology/American Heart Association Blood Pressure (BP) guideline. Whether biomarkers of chronic myocardial injury (high-sensitivity cardiac troponin T ≥6 ng/L] and stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥100 pg/mL) can inform cardiovascular (CV) risk stratification and treatment decisions among adults with elevated BP and hypertension is unclear. Methods: Participant-level data from 3 cohort studies (Atherosclerosis Risk in Communities Study, Dallas Heart Study, and Multiethnic Study of Atherosclerosis) were pooled, excluding individuals with prevalent CV disease and those taking antihypertensive medication at baseline. Participants were analyzed according to BP treatment group from the 2017 American College of Cardiology/American Heart Association BP guideline and those with high BP (120 to 159/<100 mm Hg) were further stratified by biomarker status. Cumulative incidence rates for CV event (atherosclerotic cardiovascular disease or heart failure), and the corresponding 10-year number needed to treat to prevent 1 event with intensive BP lowering (to target systolic BP <120 mm Hg), were estimated for BP and biomarker-based subgroups. Results: The study included 12 987 participants (mean age, 55 years; 55% women; 21.5% with elevated high-sensitivity cardiac troponin T; 17.7% with elevated NT-proBNP) with 825 incident CV events over 10-year follow-up. Participants with elevated BP or hypertension not recommended for antihypertensive medication with versus without either elevated high-sensitivity cardiac troponin T or NT-proBNP had a 10-year CV incidence rate of 11.0% and 4.6%, with a 10-year number needed to treat to prevent 1 event for intensive BP lowering of 36 and 85, respectively. Among participants with stage 1 or stage 2 hypertension recommended for antihypertensive medication with BP <160/100 mm Hg, those with versus without an elevated biomarker had a 10-year CV incidence rate of 15.1% and 7.9%, with a 10-year number needed to treat to prevent 1 event of 26 and 49, respectively. Conclusions: Elevations in high-sensitivity cardiac troponin T or NT-proBNP identify individuals with elevated BP or hypertension not currently recommended for antihypertensive medication who are at high risk for CV events. The presence of nonelevated biomarkers, even in the setting of stage 1 or stage 2 hypertension, was associated with lower risk. Incorporation of biomarkers into risk assessment algorithms may lead to more appropriate matching of intensive BP control with patient risk.
AB - Background: Risk for atherosclerotic cardiovascular disease was a novel consideration for antihypertensive medication initiation in the 2017 American College of Cardiology/American Heart Association Blood Pressure (BP) guideline. Whether biomarkers of chronic myocardial injury (high-sensitivity cardiac troponin T ≥6 ng/L] and stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥100 pg/mL) can inform cardiovascular (CV) risk stratification and treatment decisions among adults with elevated BP and hypertension is unclear. Methods: Participant-level data from 3 cohort studies (Atherosclerosis Risk in Communities Study, Dallas Heart Study, and Multiethnic Study of Atherosclerosis) were pooled, excluding individuals with prevalent CV disease and those taking antihypertensive medication at baseline. Participants were analyzed according to BP treatment group from the 2017 American College of Cardiology/American Heart Association BP guideline and those with high BP (120 to 159/<100 mm Hg) were further stratified by biomarker status. Cumulative incidence rates for CV event (atherosclerotic cardiovascular disease or heart failure), and the corresponding 10-year number needed to treat to prevent 1 event with intensive BP lowering (to target systolic BP <120 mm Hg), were estimated for BP and biomarker-based subgroups. Results: The study included 12 987 participants (mean age, 55 years; 55% women; 21.5% with elevated high-sensitivity cardiac troponin T; 17.7% with elevated NT-proBNP) with 825 incident CV events over 10-year follow-up. Participants with elevated BP or hypertension not recommended for antihypertensive medication with versus without either elevated high-sensitivity cardiac troponin T or NT-proBNP had a 10-year CV incidence rate of 11.0% and 4.6%, with a 10-year number needed to treat to prevent 1 event for intensive BP lowering of 36 and 85, respectively. Among participants with stage 1 or stage 2 hypertension recommended for antihypertensive medication with BP <160/100 mm Hg, those with versus without an elevated biomarker had a 10-year CV incidence rate of 15.1% and 7.9%, with a 10-year number needed to treat to prevent 1 event of 26 and 49, respectively. Conclusions: Elevations in high-sensitivity cardiac troponin T or NT-proBNP identify individuals with elevated BP or hypertension not currently recommended for antihypertensive medication who are at high risk for CV events. The presence of nonelevated biomarkers, even in the setting of stage 1 or stage 2 hypertension, was associated with lower risk. Incorporation of biomarkers into risk assessment algorithms may lead to more appropriate matching of intensive BP control with patient risk.
KW - biomarkers
KW - heart failure
KW - hypertension
KW - myocardial infarction
KW - risk
UR - http://www.scopus.com/inward/record.url?scp=85076875936&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076875936&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.119.043337
DO - 10.1161/CIRCULATIONAHA.119.043337
M3 - Article
C2 - 31707797
AN - SCOPUS:85076875936
VL - 140
SP - 2076
EP - 2088
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 25
ER -