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Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
动脉粥样硬化性心血管疾病的风险是2017年美国心脏病学会/美国心脏协会血压（BP）指南中开始使用抗高血压药物的新考虑因素。尚不清楚慢性心肌损伤（高敏心肌肌钙蛋白T≥6ng/L）和应激（N末端B型利钠肽前体[NT-proBNP]≥100pg/mL）的生物标志物是否可以告知血压升高和高血压成人的心血管（CV）风险分层和治疗决策。
来自3项队列研究的参与者水平数据(社区动脉粥样硬化风险研究，达拉斯心脏研究,和动脉粥样硬化的多种族研究)被汇总，排除患有流行CV疾病的个体和基线时服用抗高血压药物的个体.根据2017年美国心脏病学会/美国心脏协会BP指南的BP治疗组分析参与者，高BP（120至159/<100mmHg）的参与者进一步按生物标志物状态分层。心血管事件（动脉粥样硬化性心血管疾病或心力衰竭）的累积发生率，和相应的10年的数量需要治疗，以防止1例发生强烈的血压下降（目标收缩压<120mmHg），估计BP和基于生物标志物的亚组。
这项研究包括12987名参与者(平均年龄，55岁；55％的女性；21.5％的高敏肌钙蛋白T升高；17.7％的NT-proBNP升高），在10年的随访中发生825起心血管事件。血压升高或高血压不推荐使用高敏肌钙蛋白T或NT-proBNP升高的抗高血压药物的参与者的10年CV发生率为11.0％和4.6％。需要10年治疗才能预防1例重症BP降低事件，分别为36例和85例。在1期或2期高血压的参与者中，推荐使用血压<160/100mmHg的抗高血压药物，那些有与没有升高的生物标志物的10年CV发病率为15.1%和7.9%，需要10年的治疗来预防1起事件，分别为26和49。
高敏心肌肌钙蛋白T或NT-proBNP的升高可识别目前不推荐用于抗高血压药物治疗的血压升高或高血压患者，同时存在心血管事件高风险。存在非升高的生物标志物，即使在1期或2期高血压的背景下，与较低的风险相关。将生物标志物纳入风险评估算法中可能会导致强化BP控制与患者风险的更适当匹配。
来自3项队列研究的参与者水平数据(社区动脉粥样硬化风险研究，达拉斯心脏研究,和动脉粥样硬化的多种族研究)被汇总，排除患有流行CV疾病的个体和基线时服用抗高血压药物的个体.根据2017年美国心脏病学会/美国心脏协会BP指南的BP治疗组分析参与者，高BP（120至159/<100mmHg）的参与者进一步按生物标志物状态分层。心血管事件（动脉粥样硬化性心血管疾病或心力衰竭）的累积发生率，和相应的10年的数量需要治疗，以防止1例发生强烈的血压下降（目标收缩压<120mmHg），估计BP和基于生物标志物的亚组。
这项研究包括12987名参与者(平均年龄，55岁；55％的女性；21.5％的高敏肌钙蛋白T升高；17.7％的NT-proBNP升高），在10年的随访中发生825起心血管事件。血压升高或高血压不推荐使用高敏肌钙蛋白T或NT-proBNP升高的抗高血压药物的参与者的10年CV发生率为11.0％和4.6％。需要10年治疗才能预防1例重症BP降低事件，分别为36例和85例。在1期或2期高血压的参与者中，推荐使用血压<160/100mmHg的抗高血压药物，那些有与没有升高的生物标志物的10年CV发病率为15.1%和7.9%，需要10年的治疗来预防1起事件，分别为26和49。
高敏心肌肌钙蛋白T或NT-proBNP的升高可识别目前不推荐用于抗高血压药物治疗的血压升高或高血压患者，同时存在心血管事件高风险。存在非升高的生物标志物，即使在1期或2期高血压的背景下，与较低的风险相关。将生物标志物纳入风险评估算法中可能会导致强化BP控制与患者风险的更适当匹配。
