Relation of Isolated Systolic Hypertension and Pulse Pressure to High-Sensitivity Cardiac Troponin-T and N-Terminal pro-B-Type Natriuretic Peptide in Older Adults (from the Atherosclerosis Risk in Communities Study)

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Isolated systolic hypertension (ISH) and elevated pulse pressure (PP) are common blood pressure (BP) abnormalities in older adults, reflect poor vascular compliance, and can signify risk for cardiovascular outcomes. We sought to characterize the associations of ISH and widened PP with high-sensitivity Troponin-T (hs-cTnT; a marker of myocardial damage) and N-terminal pro-B-type natriuretic peptide (NT-proBNP; a marker of hemodynamic stress) levels in older adults. We performed a cross-sectional analysis of 5,251 Atherosclerosis Risk in Communities (ARIC) study participants without heart failure who attended visit 5 (2011 to 2013). We used logistic regression to evaluate the association of ISH (systolic BP ≥140 mm Hg and diastolic BP < 90 mm Hg) and quartiles of PP with detectable (≥5 ng/L) and elevated hs-cTnT (≥14 ng/L); as well as elevated NT-proBNP (≥100 pg/mL). The mean age was 75 years, 58% were women, and 78% were white. ISH was present in 24.7% and PP ≥ 70 mm Hg in 30.3% of this cohort. Compared to participants with nonhypertensive BP (<140/90 mm Hg), ISH was independently associated with hs-cTnT and NT-proBNP; adjusted odds ratio of 1.5 (95% confidence interval: 1.1 to 1.9) for detectable hs-cTnT; 1.3 (1.1 to 1.5) for elevated hs-cTnT; and 1.8 (1.6 to 2.1) for elevated NT-proBNP. Increasing quartiles of PP were also significantly associated with both elevated hs-cTnT (p-for-trend <0.0001) and NT-proBNP (p-for-trend <0.0001). These associations were not modified by BP treatment status. In conclusion, ISH and wide PP are relatively common in older adults despite contemporary BP treatment and are associated with abnormalities in hs-cTnT and NT-pro BNP, findings that could guide personalized treatment of older patients with these BP aberrations.

Section snippets

Methods

The Atherosclerosis Risk in Communities (ARIC) study is a community-based observational cohort study of adults sampled from 4 US communities: Forsyth Country, North Carolina; Jackson, Mississippi; suburban Minneapolis, Minnesota; and Washington County, Maryland. The initial recruitment and evaluation of 15,792 participants (age 45 to 64 years) occurred between 1987 and 1989. Three subsequent visits took place approximately every 3 years in 1990 to 1992, 1993 to 1995, and 1996 to 1998. A fifth

Results

The mean age of study participants was 75 years, 58% were women, and 78% were white. Approximately 75% of this older study population were on antihypertensive medication. When categorized by BP level, 73.5% of participants were classified as “nonhypertensive or normotensive” (n = 3,850), that is SBP < 140 mm Hg and DBP < 90 mm Hg, 24.8% had ISH (n = 1,298), and 1.5% (n = 87) had SBP ≥ 140 mm Hg and DBP ≥ 90 mm Hg (Table 1). In patients with ISH, the mean SBP was 152 mm Hg whereas the mean DBP

Discussion

In this large community-based cohort of older adults without baseline heart failure, we found that those with ISH or widened PP were more likely to have elevated blood levels of hs-cTnT and NT-proBNP. These findings remained robust when age and gender-specific cut-offs for these biomarkers were applied and on stratifying our study population by baseline antihypertensive medication use.

ISH is the most common form of BP abnormality in older adults.20 Indeed, some physicians have considered ISH to

Acknowledgment

The authors thank the staff and participants of the ARIC study for their important contributions. Reagents for the cardiac troponin and NT-proBNP assays were donated by the Roche Diagnostic Corporation.

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    The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under contract numbers HHSN268201700001I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I, and HHSN2682017000021. Dr. Selvin was supported by NIH/NIDDK grants K24DK106414 and R01DK089174. Dr. Lee was supported by NIH/NHLBI grant T32 HL007024. Dr. Ballantyne was supported by NIH/NHLBI grant R01HL134320, Bethesda, D.C., U.S.A.

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