Abstract 18587: Factors Associated With Changes in High Sensitivity Troponin and NT-proBNP in Response to Intensive Blood Pressure Lowering in SPRINT

Background We have recently shown that intensive SBP lowering was associated with a modest increase in hscTnT and a decrease in NT-proBNP. In the present study, we sought to compare the independent determinants of changes in biomarkers in intensive vs. standard SBP lowering in SPRINT.

Methods: Hs-cTnT and NT- proBNP were measured at baseline, 1-year, and 2-year from stored specimens. Biomarker changes were analyzed according to categories (≥50% increase, ≥50% decrease, and <50% change). The impact of intensive SBP lowering on changes in biomarkers levels was assessed using multivariable-adjusted multinomial logistic regression models in standard and intensive SBP lowering separately.

Results: Of 9,361 SPRINT participants, we measured cTnT and NT-proBNP in 8,828 (baseline), 7,887 (year 1), and 7,463 (year 2) free of CVD events. Among individuals with detectable hscTnT at baseline (≥6 ng/L), a 50% increase in hscTnT was observed in 4.5% (year 1) and 6.7% (year 2). Among individuals with baseline NT-proBNP ≥125 pg/mL, a 50% increase in NT-proBNP was observed in 16.7% (year 1) and 21.1% (year 2). Overall, a similar pattern of associations was observed with both biomarkers across treatment groups (see Figure). Several exceptions were noted. Prevalent CVD was associated with an increase in both NT-proBNP and hscTnT in the standard SBP lowering arm but not in the intensive SBP lowering arm. Higher baseline hscTnT was associated with an increase in hscTnT only in the standard arm. Furthermore, we observed biomarker-specific differences. For example, white race, female sex, and blood pressure were consistently associated with an increase in NT-proBNP. In contrast, declining renal function and male sex were associated with increasing hscTnT.

Conclusion Factors associated with changes in biomarkers varied by treatment assignment and between biomarkers. These findings highlight the role of noncardiac factors on biomarker changes in the context of intensive SBP lowering.